by Kerry Potter, MS, RD
In my very first Sunwarrior article, I introduced myself as a dietitian and diabetes specialist. I am super passionate about holistic health and am always fascinated by how our bodies work. I am not going to lie; my two favorite systems of the body are the gut and the endocrine system. It’s not to say that the other parts of the body are unimportant, but I believe that the gut and endocrine system are where a lot of underlying issues begin.
So with that being said, I want to talk about how the metabolic disease diabetes is diagnosed and give you as much information as possible to decide if your doctor is doing the right test on you to make sure you remain in optimal health for many years to come.
There are currently three ways doctors can diagnose prediabetes or diabetes.
The first one, and the one primarily used, is a fasting blood glucose (FBG) test. This test is drawn after an 8–12 hour fast. However, the thing I hate most about this test is that it only reveals your blood glucose levels in the fasting state. Our blood sugars are constantly changing throughout the day and a fasting state only gives a very small glimpse into the whole picture. According to Chris Kresser, a practitioner in integrative medicine, fasting blood glucose is the least sensitive marker for predicting future diabetes and heart disease. Now that’s just scary.
Reality is, by the time a doctor considers a fasting blood glucose level of a patient “abnormal” that individual has probably had abnormal blood glucose levels for up to ten years. It’s not like it just shows up like a cold. The American Diabetes Association (ADA) defines a FBG above 126 mg/dL as criteria for diabetes. The medical community considers anything between 100–125 mg/dL to be “prediabetes.” It’s upsetting that I find nothing being said when people’s blood glucose levels are 99 mg/dL (creeping into prediabetes) or 115 mg/dL (already prediabetic and on their way to developing diabetes). Why is there no intervention at this point in time with nutritional practices to delay the onset of a very devastating disease?
Whenever I tell my diabetes and prediabetes classes that I test my blood sugars, they respond, “Do you have diabetes?”
My response, “No.”
My classes’ reply, “Why the heck then would you test your blood sugars?”
Let me explain why.
According to the American Association of Diabetes Educators, Type 2 Diabetes progresses from an early asymptomatic state with insulin resistance, to postprandial hyperglycemia (a rise in blood glucose that is above normal after meals), eventually to impaired fasting blood glucose. At this point, you have arrived at the doctor’s office, have diabetes, and are being prescribed medications that are never addressing the root cause of diabetes. My patients are unaware that far more important than a fasting blood glucose is the number of hours a day our blood sugar spends elevated over the level known to cause complications, which is roughly 140 mg/dl.
Another test, Hgb A1C can give a practitioner and individual a little bit of a better glimpse into a person’s blood glucose patterns, including fluctuations throughout the day. This test, in simple terms, shows the amount of glucose that has been attached to a person’s red blood cells for the last 2–3 months. A person without diabetes would have an Hgb A1C between 4–5.3%. The American Diabetes Association considers an Hgb A1C of 6.5% or above criteria for diagnosis of diabetes.
However, an Hgb A1C of 6.5% means that for the last three months, an individual’s blood glucose levels have been averaging around 135 mg/dL. And that means they have probably had blood glucose levels much higher than 140 mg/dL since the test is an average. As I stated above, more important than a fasting blood glucose is the number of hours a day spent above 140 mg/dL. It’s frightening to think that by the time a person is diagnosed with diabetes, they probably have several underlying complications that will eventually surface in the years to come. Furthermore, even though an Hgb A1C can be more helpful than a fasting blood glucose, there are flaws to the test. The test can be skewed if an individual has anemia or borderline low hemoglobin levels.
The one test that I explain to my patients that I believe is super important is a post-prandial blood glucose test. You will not find many doctors doing this kind of test in their office. If a person is healthy, their blood sugar should drop below 120 mg/dL one to two hours after a meal. Actually, many healthy people will return to a normal blood glucose level of 70–100 mg/dL two hours after a carbohydrate-rich meal.
You don’t need a doctor to find out how the foods you are eating are affecting your blood glucose level. Simply go to Walmart, buy a Walmart brand Reli-On Prime glucose meter and test your blood sugars after your normal meals. This puts the knowledge and power in your hands to take charge of your health. If you find that you have some higher readings, take charge and get in touch with a integrative and functional medicine practitioner like Chris Kresser or a registered dietitian to see how you can prevent the start of a destructive disease.
References1. Tabak AG, Jokela M, Akbaraly TN, et al. Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the White-hall II study. Lancet. 2009; 373:2215-21.2. The Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New Engl J Med. 2002; 346:393-403.3. http://www.diabetes-symposium.org/index.php?menu=view&chart=4&id=322rn"
