I have certainly made it clear that diabetes is the beast we all fight against. But how do you tell if you’re on your way?
Just in case you don’t have a good answer to this question, it seems that many doctors get confused on this question as well. I recently had a new patient who told me that her primary care doctor had told her she was prediabetic. A little confused myself, I asked her some questions. She had told her primary that she had been dealing with fatigue over the past few months, so she had blood work done. Nothing terribly off, but her doctor, concerned about prediabetes, ordered a post-prandial glucose tolerance test (can’t remember, but I think it was the 2 hour variety). From this, he told her she was prediabetic and needed to go on a special low glycemic index diet. No problems with fasting glucose, triglycerides, HDL or total cholesterol.
Basically, fatigue was the only thing he was running with and looking hard to find prediabetes. By the end of a new patient interview I can tell someone with a high degree of certainty just how fast they are running towards diabetes. This women wasn’t it. Incidentally, her fatigue is a pretty clear-cut case of adrenal fatigue, further confirmed by medication for anxiety. Fatigue is not a common symptom of prediabetes.
On the flip side, I’ve had many patients over the years who had been told that they were NOT prediabetic and yet they clearly were. Most doctors seem to only look at the sugar / glucose markers: fasting glucose, HbA1c and maybe fasting insulin. But long, long before insulin has a problem getting sugars out of the bloodstream there is going to be a problem with getting fats out of the blood (refer to the glucose-fatty acid cycle of Randle from 1963 if you’d like more info on this).
In other words, do not waste time looking at glucose and HbA1c in the early part of the spectrum–they’re going to be normal. Instead, look at the triglyceride and HDL level. THIS is probably one of the best screening tools to get a quick guess about where you are (or are not) on the diabetic spectrum. Which brings us to this particular article. In it, researchers looked to see what ratios between HDL and triglycerides were of concern in 2,244 healthy college students (17–24 years old) of Mexican Mestizo ancestry. Here’s what they found:
- The highest 25% TG/HDL-C ratio was used to identify those with prediabetes who were at increased risk of heart disease.
- Heart disease risk factors were greatest in those whose TG/HDL-C ratios exceeded 3.5 (men) and 2.5 (women).
Personally, I don’t like to see the ratio get much above 2, but I’m pretty picky. Normal triglycerides are considered below 150 mg/dl and normal HDL should be greater than 40 mg/dL (men) and 50 mg/dL (women). As an example, a man having “normal” levels could have a ratio of 3.75–way too high. But if your doctor does not recognize this fact, you’ll be sent away with mistaken reassurances that everything is doing ok.
As a side note, don’t confuse this ratio with the “good” to “bad” cholesterol ratio–the triglyceride to HDL ratio is far more important.