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Southern Ocean County Hospital would like to thank everyone who e-mailed questions for this edition of Ask-The-Expert and would like to especially thank Dr. Hussain for taking part in the program.

June: Diabetes

Question 1
I had a blood test 2 years ago to see how my insulin in by body is using sugar and it was 5.2. I was put on glucophage 1000 mg 2 times a day and seemed to be able to lose weight. Now the same blood test came back at 9.1, I guess indicating that my insulin is not using sugar in my body correctly. I do not fully understand what these test results indicate, and what further testing I should ask my doctor to do. Do you think that it is possible that my medication needs to be changed? When I was called with my test results, the nurse said that the doctor had no notes by my results. I am a little concerned. I have been extremely tired lately, and unable to lose more weight. Any insights for me? Thank you.

I am assuming that these are insulin levels. In the presence of normal to high blood glucose readings, mildly elevated insulin levels like these, suggest insulin resistance. Insulin resistance means that the mechanism that transports glucose from the bloodstream into the cells, does not work well inspite of the there being plenty of insulin around. Therefore the pancreas is producing a higher than normal amount of insulin to try to compensate for this.

The fact that the second level was a little higher than the first one does not necessarily mean that you are doing worse than before, because the insulin level normally fluctuates from day to day and even from hour to hour. In people who are over weight, insulin resistance does respond to wt loss. The decision to adjust medications is based more on the blood glucose and the HbA1c test than on the insulin level. If those are still above normal, then ask your physician if another diabetes medicine needs to be added to the metformin. I would encourage you to keep on losing weight until your wt is normal. It is very easy to get dehydrated while you are trying to lose weight. Your fatigue may be due to dehydration. So drink plenty of water especially on hotter days.

Question 2
I am recently diagnosed with diabetes. For the most part, my blood glucose numbers have been good with only some readings over 125. My 30 day average (per my home testing) is 116. Do I actually have diabetes? I am taking 5 mg Metformin with dinner and watching my diet.

If your glucose readings were higher before starting the metformin and are under control now, then you do have diabetes. Diabetes is a chronic disease and medications need to be taken long term to keep it under control. Discontinuation of a medicine may cause the glucose level to go back up again. However if you were over weight to begin with, it is possible that after significant weight loss your physician may be able to taper you off the metformin and the glucose will stay under control with just diet and exercise.

Question 3
I just had an AC1 blood test, my test results came back 6.9. MY doctor said I am still borderline. My sugar readings when I test them in the mornings have been high. Ranging from 140-220. I am under alot of stress and anxiety could this be affecting my readings. Also should I have further testing. MY father had type 11 diabetes.

Your test results show that you do have diabetes, and you are not "borderline". Your family history suggests that you have type 2 diabetes. Sugars running at this level for a long time can lead to diabetes complications. If these sugar readings do not improve with diet and exercise within the next few weeks, then I would add an oral diabetes medicine to bring them down. Stress and anxiety can raise the blood sugar level but we still need to bring it down. Once the stress is gone and the sugars are normal, then a decision can be made whether your medicine can be discontinued.

Dr. Hussain's answers are informational only and should not be used as a diagnosis or for treatment. Please talk to your physician about official diagnosis of your condition and treatment.