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January 31, 2012
Diabetes Mellitus cont.

Last week we looked at the condition called diabetes or sugar. This week, we will look at how we diagnose diabetes. In other words how do you know that you have “sugar”?

Usually, most people who develop sugar do not know when they develop it. In other words they have no specific symptoms.{{more}} Some people say they suspected it because they had itching of the skin (“me skin was scratching me doc”). Others say they had weight loss, even though they were eating a lot and feeling hungry. Still some will say that they were “peeing” a lot or drinking a lot of water, because they were always feeling thirsty. These are the usual symptoms of diabetes. However, a lot of people will have no symptoms at all and will be “picked up” just on routine testing at their doctor’s office.

Rarely, some people will just “come down with sugar”. This means that they had sugar and did not know, but when they picked up an infection or something acute and were admitted to the hospital then the sugar was diagnosed. Even more rare are those people who suffer a heart attack, a stroke or a diabetic coma, only to realize that the problem was caused by sugar, when they are in the hospital.

We doctors know that you have sugar because we test your “blood sugar”. The sugar is usually tested when you are fasting. The fasting sugar should be less than 6.2mmol/l (the international units) or 110mg% (the American units). If a random sugar is taken (a blood sugar test after you have had something to eat) it should be less than 11.1mmol/l (200mg%). If you have a random sugar of more than 200mg% you most likely have sugar, but you need a fasting sugar to diagnose the condition, because some patients will have a slightly raised random blood sugar, but the fasting blood sugar will be normal. These patients have glucose intolerance; in other words their bodies cannot cope with sugar. These patients’ sugar will be controlled with a change in diet.

Likewise diabetics whose sugars are marginally raised can usually be controlled on diet and exercise, especially if they are obese and have type 2 or adult onset diabetes. These patients are usually told that they have a “touch of sugar”.

Some persons will have a diagnosis of sugar made without a fasting blood sugar (FBS), because the sugar level is very high and the patient is sick, even though they were never diagnosed with sugar. The sugar is usually 300 or 400mg%. These patients will be started on medication even without a fasting blood sugar. Some patients with glucose intolerance or a “touch of sugar” are placed on medication, because they cannot stick to a diet and exercise program. These patients usually have elevated glycosylated hemoglobin levels. This hemoglobin is popularly known as the hemoglobin A1c or HbA1c. The normal HbA1c levels are less than 6.5% or 61/2%. Anything above this means you have diabetes, but mild if less than 7%, i.e. HbA1cs between 61/2 and 7% signify mild diabetes if not on medication. If on medication then a HbA1c of less than 7% signifies good control.

We will discuss HbA1c in another article. Suffice it to say the HbA1c can be used to adjudicate when you cannot differentiate between glucose intolerance and mild diabetes just based on blood glucose levels, because sometimes the tests are high and sometimes they are borderline or normal.

As you will also see, HbA1c is also used to tell us how well controlled your sugar is when you are on medication. Next week we will look at the reasons why we should treat sugar.

For comments or question contact:
Dr. Rohan Deshong
Tel: (784) 456-2785
email: deshong@vincysurf.com