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Dr. Andrew Rynne

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Suggest treatment for type 2 diabetes

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Dr. Saumya Mittal

Diabetologist

Practicing since :2004

Answered : 2870 Questions

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Posted on Thu, 9 Mar 2017 in Diabetes
Question: Hello, I was recently diagnosed with diabetes type 2. The first a1c test was 6.9 at hospital, where it was suggested I see my family doctor. I did later that day. My blood & urine was tested. I received a 6.6 a1c, & was diagnosed type 2. Was the interval between a1c tests too short, how long should they be between testes, was I wrongly diagnosed?
doctor
Answered by Dr. Saumya Mittal 49 minutes later
Brief Answer:
Information

Detailed Answer:
Hello,
I am Dr Mittal.
I have read your message.
I can help you.
There are 2 parts to your query.

Glycosylated hemoglobin or HbA1C is a test that tests the long term control of sugars in a person.
This is usually done at an intervals of 3 months at least.
So if you have done the two tests before 3 months of each other, the latter is probably not needed.

The diabetes cannot be diagnosed by just 1 criteria. To diagnose diabetes, with or without symptoms, one needs FBS, PPBS and HbA1c tests. At least 2 of these tests should be suggestive of diabetes.
HbA1C of 6.9 should be considered highly suggestive of diabetes.

I have given the information you needed. In view of lack of information in the query, I will not be able to give you the direct answers to the query. The information lacking is-
1. the dates of the 2 tests.
2. FBS and PPBS reports.

Please let me know the information for further suggestions.
Please feel free to contact me for any further clarification.
Best of luck, Dr Mittal
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Saumya Mittal 17 minutes later
Hello Dr. Mitral. Thank you sir for your help. It is heartfelt. The answer to question 1. Is the same day. Both a1c 6.9 & 6.6 respectively. A week later a 3rd a1c by another physician was 6.7. As for question 2. I don't know. Is pre diabetes/type 2 diabetes reversable, or totally cureable? With the utmost respect, thank you Dr. Saumya Mittal.
doctor
Answered by Dr. Saumya Mittal 11 minutes later
Brief Answer:
Information n suggestons

Detailed Answer:
Thank you for your response.

The HbA1C variation on the same day is probably machine variation.
So the second report is not essential.
Ideally speaking, even the report of third week is not needed, but your treating doctor probably wanted to see some response to therapy and therefore it is acceptable.
Test the next HbA1C 3 months after the first test.

Second, test FBS , PPBS. In fact I would suggest that you should buy a glucometer and monitor sugars regularly and make a record of your sugars. For most diabeticians, this record is more important than HbA1C.

Third, I wont label this as prediabetes without FBS, PPBS reports. There is no cure for diabetes. Diabetes cannot be cured. It can only be controlled with medicines, exercise regime and dietary restrictions. Which meas that once you develop it, it remains life long. It can be controlled by the 3 measures I mentioned. But if you stop the 3 measures, it will rise again.

I read that you have lost 60 lb. That is a very good thing for diabetes, especially type 2. But do not rely solely on diet and exercise. And here is where the glucometer, FBS and PPBS get important. They can record the daily sugars. So you do not have to wait 3 months to know whether you are improving or deteriorating.
If FBS, PPBS remain high, medicines may need to be initiated.

I dont mean to scare you. But diabetes is not to be taken lightly. High sugars can damage every system in the body. Therefore controlling sugars is essential.

Please feel free to contact me for any further clarifications.
Best of luck, Dr Mittal
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Saumya Mittal 1 hour later
Thank you Dr. Mittal. I have been using glucometer for about a month now. In that time my fasting levels have been consistently between 4.8 @ 6.5. My 2hrs after a meal have been consistently between 4.0 & 5.8. Why are my fasting numbers almost always slightly higher? What's your opinion on these numbers? Can I continue, without medication? With the highest respect sir.What should my range in target numbers be, both fasting & after a meal? Thank you again, Dr. Mittal.
doctor
Answered by Dr. Saumya Mittal 6 minutes later
Brief Answer:
Explained, and suggestion

Detailed Answer:
Thank you for your response.
I think as of now you can continue with the exercise regime and diet control.

The reason and physiology behind the sugar levels is a bit difficult to explain.
Understand it this way- insulin is needed for lowering blood sugar. You are type 2 diabetes, so insulin is secreted, but is inefficient, and hence insufficient. So, once you start with diet control, and weight loss, the amount of insulin secreted becomes sufficient. Therefore sugars become lower.
Please understand, this is oversimplification of the way it actually works.

I have tried to make it as simple as possible.
Feel free to contact me for a clarification on any of the attributes of the query.
Best of luck, Dr Mittal
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Saumya Mittal 20 minutes later
Thank you Dr. Mittal. For simplifying it. You have been most helpful. Please tell me what my approximate target numbers should range, both fasting & after meals, in your expert opinion? Respectfully yours, XXXXXXX Terkalas.
doctor
Answered by Dr. Saumya Mittal 2 hours later
Brief Answer:
Range

Detailed Answer:
hello again.
the target sugar range varies from doctor to doctor , patient to patient and condition to condition.
The point is that hypoglycemia or reduced sugars should be avoided as far as possible.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Saumya Mittal 6 hours later
My final question is... How is diabetes initially diagnosed? 2 a1c tests in the same day? Which is how I was diagnosed (wrongly I believe). 2 a1c tests, a week apart?Or the first a1c test, and then a second a1c test 3 months later? Please tell me.
doctor
Answered by Dr. Saumya Mittal 1 hour later
Brief Answer:
Information requested

Detailed Answer:
Hello again.
First you are not wrongly diagnosed.

The HbA1C is high and that suggests diabetes, as I have already mentioned.
Of course the other 2 tests- FBS and PPBS also need to be done.
And your sugar readings that you've mentioned here , taken from glucometer are also raised.
Normal fasting cannot be above 5.5 mmol/L.

The only thing is that, your subsequent HbA1C might not have been needed.
The followup HbA1C needs to be done 3 months after the first.
Meanwhile monitor your sugars with glucometer.
If they are consistently 7 to 7.8 mmol/L or more, you may need to start medications.

Do check lipid profile, KFT, urine microalbumin and echocardiography annually.

I have tried to make it as simple as possible.
Please feel free to contact me for any further information or clarification at any point.
Best of luck, Dr Mittal

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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