Blood Sugar Levels: Are You at Risk for Diabetes?

Q: Blood Sugar Levels: Are You at Risk for Diabetes?

Dear Mr. Alex： 1. A fasting blood glucose level of 95 mg/dL or 96 mg/dL shows no significant change clinically; in other words, it lacks significant meaning. Based solely on this value, no physician would suggest that it will soon exceed 100 mg/dL. Generally, b

Blood sugar issues?

Hello Doctor, I am 168 cm tall and weigh 57 kg.
I had a health check-up at a major hospital in early October this year, where my fasting blood glucose level was 95 mg/dL.
Since this value is close to the upper limit of the normal range, I was quite worried about the possibility of being in the prediabetic stage or approaching it.
However, the doctors reassured me that there was no need to worry too much, but I still feel anxious because I found out online that diabetes diagnosis is not solely based on fasting blood glucose; it also requires postprandial blood glucose and glycated hemoglobin (HbA1c) measurements.
If any one of these values exceeds the standard, it could indicate a risk of diabetes.
To alleviate my concerns, I recently (on December 15) went back to the hospital for tests on fasting blood glucose, postprandial blood glucose, and HbA1c.
The results are as follows: Fasting blood glucose GLU-(AC): 96 mg/dL, Postprandial blood glucose GLU-(PC): 85 mg/dL, HbA1c: 5.5%.
I have a few questions for you:
1.
With a 2.5-month interval, does the increase in fasting blood glucose from 95 mg/dL to 96 mg/dL indicate that it may soon exceed the normal range (>100 mg/dL)?
2.
Is it normal for the postprandial blood glucose (85 mg/dL) to be significantly lower than the fasting blood glucose (96 mg/dL)? (On that day, I waited a long time for my appointment; the fasting blood sample was taken at 11:30 AM, and the postprandial sample was taken two hours after my first bite of lunch at noon.)
3.
I walked around the hospital for two hours between lunch and the blood test (walking intermittently without sitting down).
Could this have affected the postprandial blood glucose results?
4.
The HbA1c level of 5.5% is within the normal range, but it seems somewhat elevated.
Based on the fasting, postprandial blood glucose, and HbA1c results, am I considered to be at risk for diabetes?
5.
Based on my test results, how long should I wait before returning to the hospital for further testing? Thank you.

Alex, 20~29 year old female. Ask Date: 2016/12/19

Dr. Xiao Yongxun reply Internal Medicine

Dear Mr.
Alex:
1.
A fasting blood glucose level of 95 mg/dL or 96 mg/dL shows no significant change clinically; in other words, it lacks significant meaning.
Based solely on this value, no physician would suggest that it will soon exceed 100 mg/dL.
Generally, blood glucose levels fluctuate throughout the day due to various factors such as food intake, exercise, emotions, basal metabolism, stress, and illness.
From an endocrine perspective, hormones like insulin, glucagon, somatostatin, epinephrine, and cortisol all play a role in regulating blood glucose levels to meet the body's needs.
2.
A fasting blood glucose level of 96 mg/dL and a postprandial blood glucose level of 85 mg/dL two hours after a meal indicate that the postprandial blood glucose is lower than the fasting level.
At first glance, this seems contrary to the fact that postprandial glucose levels are usually higher.
However, we often observe this situation clinically.
Why? Because healthy young individuals have well-functioning pancreatic glands and normal secretion of gastrointestinal incretins, leading to robust and efficient insulin secretion and action, which results in a rapid decrease in blood glucose.
Therefore, your situation should be considered normal.
3.
Engaging in post-meal walks or regular exercise improves insulin receptor sensitivity, making insulin action very efficient, which naturally lowers the blood glucose level two hours after a meal.
4.
Risk factors for developing type 2 diabetes primarily include being overweight (body mass index > 24 kg/m²), lack of physical activity, having first-degree relatives with diabetes, a history of gestational diabetes, hypertension, hyperlipidemia, polycystic ovary syndrome, hemoglobin A1c ≥ 5.7%, abnormal fasting blood glucose, abnormal glucose tolerance tests, obesity or acanthosis nigricans, and cardiovascular diseases.
Therefore, I believe you are currently not part of the high-risk group for diabetes.
5.
Your body mass index is 20.2 kg/m², fasting blood glucose is 96 mg/dL, postprandial blood glucose is 85 mg/dL, and hemoglobin A1c is 5.5%; all of these values are normal.
Thus, I believe that unless you experience specific health issues, an annual check-up should suffice.
6.
Your primary care physician is very competent and has made accurate judgments; please be sure to discuss your concerns with them thoroughly.

Reply Date: 2016/12/19

More Info

Based on your recent blood test results and your concerns regarding diabetes risk, let's break down your questions and provide a comprehensive understanding of your situation.

1. Blood Sugar Trends: Your fasting blood sugar increased slightly from 95 mg/dL to 96 mg/dL over two and a half months. This minimal increase is not significant and does not necessarily indicate that you will exceed the normal range (>100 mg/dL) soon. Blood sugar levels can fluctuate due to various factors, including diet, physical activity, and stress. It's essential to monitor these levels regularly, but a single point increase does not warrant immediate concern.

2. Postprandial Blood Sugar Levels: Your post-meal blood sugar level of 85 mg/dL is indeed lower than your fasting level of 96 mg/dL, which is typical. After eating, blood sugar levels usually rise, but they can vary based on the meal's composition and your body's insulin response. In your case, a postprandial level lower than the fasting level is unusual but can occur, especially if you were active before the test. It indicates that your body is effectively managing glucose levels, which is a positive sign.

3. Impact of Physical Activity: Engaging in physical activity, such as walking around the hospital before your blood test, can influence your blood sugar levels. Exercise typically lowers blood sugar levels by increasing insulin sensitivity and promoting glucose uptake by muscles. Therefore, your activity could have contributed to the lower postprandial reading.

4. Glycated Hemoglobin (HbA1c): Your HbA1c level of 5.5% is within the normal range and indicates good blood sugar control over the past two to three months. While it is on the higher end of normal, it does not place you in the prediabetic or diabetic category. According to the American Diabetes Association, an HbA1c of 5.7% to 6.4% indicates an increased risk for diabetes. Therefore, your current level suggests that you are not in the diabetes danger zone.

5. Monitoring Frequency: Given your current results, it would be reasonable to have your blood sugar levels checked annually, especially if you maintain a healthy lifestyle, including regular exercise and a balanced diet. If you have any changes in weight, lifestyle, or family history of diabetes, you may want to consult your healthcare provider about more frequent monitoring.

In summary, your current blood sugar levels and HbA1c indicate that you are not at high risk for diabetes. However, it is essential to continue monitoring your health, maintain a balanced diet, and engage in regular physical activity. If you have further concerns or notice any changes in your health, do not hesitate to reach out to your healthcare provider for personalized advice and potential further testing.

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