Dr. Sagar Ramesh Makode
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am concerned about the fasting glucose level. I just received the results from blood tests taken a week back and I am a bit concerned about my fasting glucose level. On this most recent test, my fasting glucose was 103 mg/dL. I had a full physical eight months back. At that time my fasting glucose was only 86 mg/dL. This rapid rise is of great concern to me as my mother has type 2 diabetes. The doctor did not request an HbA1c test. But, my cholesterol levels were good. Total cholesterol was 185. Triglycerides were 115, which was higher than the previous test. Then they were 73. Also, I am 6 feet tall. My current weight is 200 pounds. My weight earlier was 190. Current waist circumference at widest point is 38 inches. I am very physically active, exercising for an hour at least five days each week. I thought my diet was generally good. I do drink alcohol but rarely more than 2 or 3 beers once or twice each week.
Here are my questions. How concerned should I be about the rise of my fasting glucose level? Could this result be in error due to anxiety or drinking alcohol a few nights prior? Could gaining 10 pounds in six months have led to this increase in fasting glucose? What should my next step be? I do not want to develop diabetes like my mother.
Hello,
Welcome to icliniq.com.
Firstly, we do not rely so much on a single report. Because, there are multiple factors which may affect the fasting readings like as you mentioned stress level, alcohol, diet on the previous day, etc. So you need to check it again after an interval of two weeks. Also, weight gain of pounds can also raise your level to some extent by increasing insulin resistance, so there must be a component of true elevation as well. Your triglyceride level is also increased which goes in hand with your weight so need to have a control over diet. So this elevation is also subjected to various factors like whether fasting or not, previous date meals, etc., to some extent, but there must be true elevation as well as your weight has also increased.
So, the fasting is elevated a bit but within normal range only (less than 110). So you need to take all precautions to prevent further rise. So important is diet and exercises. You should try to achieve some weight loss at least. Diet low in calories, fatty and oily component, an excess of green leafy vegetables, and fibers will help in controlling both levels. Also, less of refined carbohydrates and soft drinks. Try to keep alcohol consumption at the lowest level. No smoking, if you do.
Patient's Query
Hi doctor,
My recent tests results were confusing. I cannot speak to my physician for a few weeks, and I'd like to get your opinion since information boards on the internet are so contradictory. After my previous query, My a1c results have been good -- trending slightly downward. However, my fasting glucose levels have been up and down, depending upon weight and stress levels.
Here are the results:
A1c:
March 2021 -- 5.4
July 2020 -- 5.4
March 2020 -- 5.5
April 2019 -- Not tested
Fasting Glucose
March 2021 -- 108
July 2020 -- 97
March 2020 -- 105
April 2019 -- 96
I am very concerned since my mother is diabetic, and I do not wish to follow suit. The steady (improving) A1c results seem positive. However, the fasting glucose numbers seem to be yo-yo-ing and increasing slightly over time. Is this cause for concern? What steps can I take to improve my fasting glucose in a lasting way? I don't drink heavily (2 to 6 drinks once or twice a week), and I do not eat sweets. I exercise vigorously for an hour a day, five or six times a week. My current weight is approx. 195, and I am six feet tall. I'm looking for some good news or at least something that will ease my mind. Hoping I'm not headed irreversibly towards diabetes like my mother.
Thank you.
Hello,
Welcome back to icliniq.com.
I don't see there is any reason to worry about it. Fasting glucose is a highly variable parameter, and comparing it over some time in such a fashion may be misleading. However, HbA1C is more reliable in this regard. So as HbA1c is showing a good trend, then there is no need to worry about it.You are doing good at present. However, I can see your BMI is 26.4 with the provided parameters. So there is scope for losing some more weight. So can target for BMI 2-3 points lower. So there is nothing to worry about it, and losing some weight remains an option.
Thank you.
Patient's Query
Hi doctor,
I just received my latest blood work results. And I’m as confused as ever. I cannot get in to see my doctor for a week. So to ease my mind, I was hoping you could help me again. My fasting glucose returned at 102, but my HbA1c came back at 5.2 — the lowest it has ever been.
Since my results in March of 2021, I have lost 15 pounds. I’m down to 180. I felt great and was hoping I had put all this behind me. I have a fair amount of anxiety about these tests. I think it is why my bp is always higher at the doctor's office than at home. Could this be the reason for my slightly elevated fasting glucose? Or could something more be at play? I’m very concerned about diabetes since my mother has it. I’m trying to do everything to avoid that fate. Would you consider me pre-diabetic? Should I consult a specialist? Or do you think I’m okay and need to manage my anxiety?
Thank you
Hello,
Welcome back to icliniq.com.
Your fasting glucose is well within the normal range. Fasting glucose less than 110 is average, while 110 to 126 is prediabetic. So you are not prediabetic either and need not worry about it. You don't need to consult anyone for this; however, just continue with your healthy lifestyle and keep your BMI in the normal range. If home BP readings are regular and only office readings are high; it's due to anxiety (white coat hypertension). And need not worry about this as well. If you focus on anxiety management, stay busy in the work or hobbies, do meditation, etc., for anxiety, besides medication.
Thank you.
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