What’s up EnDoc?
Bien J. Matawaran, MD, DPSEM
This column is the obligatory question and answer portion of Hormone Hotspots. We will entertain any questions about Endocrinology & Metabolism from all of you—patients, friends, colleagues and even enemies (just don’t hold your breath waiting for the answer. I will try to be simple minded as possible (as if I can try to be otherwise) so that comprehension of endocrine topics will hopefully be easier. I will be your resident Joe D’ Mango/ Kuya Cesar cum Helen Vela— well known “showbiz advisers”, until the editors can find a qualified and saner writer for this column. But for now you don’t have a choice but read on or tear this page ASAP.
Just want to let you in on a little secret… my Editor is fuming mad since I’ve been procrastinating. Such a bad habit for a doctor whose main object is to get to targets FAST. I was not able to turn over my article on time mainly because YOU have been procrastinating. I’ve been waiting for your queries, so turn over those questions fast!
1. An abbreviated (sarcasm) question from a distraught patient ….I’ve been very conscious about my health since I just discovered that all my brothers and sisters turned out to be diabetic. It was probably not much of a surprise since my father was likewise diabetic and was obese. Since then, I’ve been checking my fasting blood sugar (FBS) every 3months and all have been normal except for the most recent which showed a value of 119 mg/dL (6:61 mmol/L) which my doctor said was ‘prediabetes’. What does this mean and should I take any medications for this condition?
Answering this patient with regards to the diagnosis of ‘Pre-diabetes’ is quite easy but the question on treatment is one winding path to tread. Pre-diabetes is a term applied to blood glucose determination showing values above normal but are below the threshold for the diagnosis of diabetes mellitus. This term includes the condition we call “Impaired fasting glycemia” and “Impaired glucose tolerance.” Determination of fasting blood glucose, done after an overnight fast of at least 8 hours, is the simplest way of diagnosing diabetes mellitus. Normal blood sugar for non-pregnant individuals is defined as less than 100 mg/dl (5.5 mmol/L) and diabetes mellitus as a value of more than or equal to 126mg/dL (7 mmol/L). So if you have a FBS value of between normal blood sugar and diabetes mellitus, then this is impaired fasting blood sugar that is ‘pre-diabetes.’ This only means that you are at a greater risk to develop diabetes in the future. These values are based on epidemiologic studies that are utilized by the American Diabetes Association (ADA) as well as the International Diabetes Federation (IDF) in its guidelines.
The meat of the question is harder to answer, and that is if she needs treatment. There are several studies done specifically to patients with prediabetes to evaluate the effect of different interventions-diet and exercise, metformin, rosiglitazone, pioglitazone, acarbose and orlistat, to ‘prevent’ diabetes mellitus type 2. These interventions have been proven effective however; it is still lifestyle modification that has provided a more favorable result. So in this group of patients what I usually say is that if they can sustain lifestyle modification and lose weight, then they would not need any tablets to reverse pre-diabetes.
2. Still on risk for diabetes, my sister has been bugging me regarding her blood sugar. She is a 32 year old mother of one who developed gestational diabetes mellitus (GDM) or diabetes during pregnancy, necessitating insulin therapy. I had this stressful situation of taking care of her blood sugar during the duration of her pregnancy, making sure that she sticks with her diet, blood sugar monitoring and insulin injections. After delivery, her blood sugar returned to normal so now she would like to know if she can now binge and enjoy food as our family is known for being “voracious eaters”?
To be truthful about it, she can actually take in anything she likes since she’s not a diabetic. However I also tell her that we have a family history of diabetes mellitus and she is far from model slim. Her history of gestational diabetes actually increases her risk to develop diabetes mellitus in the future, that is in addition to all her other previous risks. As mentioned above, you can also consider gestational diabetes mellitus as a pre-diabetic state.
WHAT’S UP AND WHAT’S NOT!
If you want to know a government initiatives regarding diabetes mellitus, log on www.doh.gov.ph and click on public health programs. You would be surprised that diabetes is clumped up with Diabetes, Osteo, Arthritis, Musculo-skeletal. Is that not unfortunate?
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