Pre-Diabetes or nothing to worry about?

Patient

Q: I am a 40 year old active female, no weight issues (5’10, 130Ibs), 18% body fat. Slightly high Fasting Blood Glucose levels on 3 different recent blood draws led to Doc sending me for an Oral Glucose Tolerance test, which came back fine but due to the higher fasting blood glucose levels, he instructed me to test at home myself for a few months with a meter to figure out what is going on. Numbers are good on most days that I eat my normal healthy diet, but on the weekends when I spurge more, my numbers are sometimes staying around 130 until 4 hours after I have eaten! I have had 2 different opinions from the Docs on this. One says this is totally normal and that I don't have pre-diabetes because of the normal OGTT, and the other Doc says I do have pre-diabetes due to my higher postprandial numbers.

I eat around 130 carbs daily during the weekdays (Breakfast: plain organic oatmeal w skim milk, ground turkey. Snacks: seeds & nuts, Lunch: spinach & broccoli salad w berries & banana. Dinner: lean meat with more veggies, only water to drink, no coffee, soda, sweets, junk or processed food). On the weekends I do splurge more, for example on Saturday I may have 3 slices of pizza instead of the salad for lunch. And on Sunday I may have a burger and fries at a restaurant for one meal. And I may have a serving of ice cream at some point too. I have heard eating “low carb” can cause your blood sugar to go extra high when you do splurge on carbs, so I wonder if that is what is happening with me? I don’t know if my usual 130ish carbs counts are “low carb” though? And if this is the cause, maybe I need to eat more carbs during the week to avoid the spikes when I do splurge? Or maybe I need to totally give up the splurges?

Fasting Blood Glucose at lab: 101, 105, and 107 mcg/dL on 3 different occasions
Oral Glucose Tolerance Test at lab: GLU GTT-FAST: 99 mg/dL, GLU GTT-2HR: 84 mg/dL
Insulin: 7.6 uIU/mL (range of 2.6 - 24.9)
Examples of Blood Glucose testing at home during week when I am eating less carbs:
Fasting: 90, 95, 100, 103, 106
1 Hour after Breakfast of plain organic oatmeal w skim milk and ground turkey: 157, 117, 100, 93, 106,
2 Hours after this same breakfast: 98, 94, 85, 88, 83
1 Hour after lunch of spinach & broccoli salad with berries and banana: 104, 89, 99, 102, 101
1 Hour after dinner with lean meat and veggies: 95, 88, 99, 95, 100

Examples of Blood Glucose testing at home during weekend when I eat more carbs:
Fasting: 90
1 Hour after plain oatmeal w skim milk: 117
2 Hours after plain oatmeal w skim milk: 94
1 Hour after 3 slices pizza: 162
2 Hours after 3 slices pizza: 140
1 Hour after hot fudge sundae: 145
2 Hours after hot fudge sundae: 108

Different day:
1 Hour after chicken and rice with veggies: 144
2 Hours: 131

Different day:
1 hour after pizza: 130
2 Hours: 111

Different day:
1 hour after sausage, egg, and cheese quesadilla with hash browns: 79

Different day:
1 hour after ice cream sundae with hot fudge: 126
2 hours: 134
3 hours: 123
4 hours: 94

Different day:
1 hour after restaurant hamburger & fries: 140
2 hour: 129
3 hours: 123
4 hours: 88
(I have many more examples similar to this in my 2 months of home testing, but you get the idea)

Also, I did have an HA1C (5.3) a little over 4 years ago, because my eye doctor found a lot of cataracts and also some retinal hemorrhages and damaged blood vessels in my eyes. I also had a few spells of double vision back then. All of this has resolved, but we never really found a cause, and I know eye problems like this can sometimes be related to diabetes, so that is only reason I mention this. Again, this was over FOUR YEARS ago, and my yearly eye exams have been clear since (except for the cataracts which of course don’t just go away), so this may no longer be relevant.

Everything I read says to lose weight for prediabetes, but I am right on the border of underweight as it is. I exercise 5 days a week, walk about 3 miles a day, and then run about a mile as well, plus about 30 mins of strength training 3-4 days per week. I get 8 hours of sleep and am not especially stressed out or anything. Other than cut out the 2-3 splurge meals I have per week, I am not sure what else to do?

Do I have prediabetes/Insulin resistance?
If so, what can I do to reverse it?
Isn’t FOUR hours a little long after eating for blood sugar to go back down?
Could this all be due to the lower amount of carbs my body is used to getting through the week?
How do you explain the normal OGTT, but high postprandial numbers?
Are there any other possible causes of the higher fasting and postprandial numbers besides prediabetes/insulin resistance?

Symptoms:  Fasting Blood Glucose numbers in prediabetic range, Normal OGTT, high postprandial numbers up to 4 hours after eating
Doctor

A:   Thank you for writing to Ask The Doctor

I have gone though your question and I do not see a reason to believe that you may be dibetic. Even though you may have symptoms of diabetes, I find that your tests are normal.

Your GTT appears to be normal and you HbA1c reports are also below 7 % which is within the normal range.

There are a few findings in your case that are suggestive of problems with glucose levels but I do not think they are related to diabetes. One thing that concerns me are the cataracts that you have. Certain glucose storage disorders can also cause cataracts.

It might be a good idea to get a GTT done by a doctor to confirm if it is normal. Other than that, I think that everything else seems to be good.

I hope this helps you. All the best.

Comments / Follow Ups

Patient: I am confused by your response, "It might be a good idea to get a GTT done by a doctor to confirm if it is normal"......as stated in my question, I just had a normal GTT done. Also, I realize I am not diabetic -- that was not my question. My question was in regards to prediabetes. Also, I am unsure that the HbA1c from over 4 years ago is relevant here? What sort of glucose storage disorder are you concerned about?
Doctor: Thank you for the follow up.

I am sorry I thought that you had done all the tests at home because I saw the various reports that you had. A GTT is usually done using about 75 grams of glucose at a time. I had misread that test because of looking at the various values of glucose that you had given.

One reason I mentioned the HbA1c level is because it shows the long duration control of sugar levels. If you have always been weighing about 130 pounds, then it is unlikely that you had diabetes type 2. In type 2 diabetes, obesity is usually seen which leads to an increase in the resistance to insulin.

I do not think this happened in your case.

Storage disorders can cause cataract in some cases and since you had a positive finding of cataract a few years back, I was just giving you a possible reason for that. Many storage disorders can cause this and I would not be able to point you to one.

I hope this helps you. All the best.

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