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What Does My Blood Sugar Test Indicate?
Question: Hello sir,
I m 29 years old person. 2 months back I have detected Diabetes. At first diagnosis my sugar was 465. HBA1C was greater than 13. I have strong history of type 2 diabetes. My both parents and my grand father have type 2 diabetes.
My would wanted to know whether I m type 1 diabetic or type 2 diabetic. For your help I have run some test with below result:
Insuline fasting-11.46
Insuline pp-71.66
C peptide fasting-1.23
C peptide pp-6.85
Kindly help me in diagnosis.Currently I m on Insuline. Can I come on oral medication in near future. Can my diabetes reversible if followed proper plan.
I m 29 years old person. 2 months back I have detected Diabetes. At first diagnosis my sugar was 465. HBA1C was greater than 13. I have strong history of type 2 diabetes. My both parents and my grand father have type 2 diabetes.
My would wanted to know whether I m type 1 diabetic or type 2 diabetic. For your help I have run some test with below result:
Insuline fasting-11.46
Insuline pp-71.66
C peptide fasting-1.23
C peptide pp-6.85
Kindly help me in diagnosis.Currently I m on Insuline. Can I come on oral medication in near future. Can my diabetes reversible if followed proper plan.
Brief Answer:
Genetic diabetes
Detailed Answer:
Hi Sir,
I have carefully read your query and understand your concern.
Going by your lab data the elevated uncontrolled blood glucose( as per elevated blood glucose and HB1ac) with normal fasting and postprandial insulin levels with normal fasting C peptide levels and elevated postprandial strongly point to a specific new form of diabetes which is neither type 1 nor type 2.
This is called Monogenic(Genetic) diabetes and MODY-Maturity onset diabetes mellitus of young in my opinion as 2 generations are affected.
Note:
1.Results should be confirmed only after genetic testing for the concerned genes for final diagnosis.
2.The current diagnosis is based only on the clinical and lab profile data.
This is characterised by atypical features of lack of insulin autoantibodies favouring type 1 or lack of insulin resistance features like acanthosis nigricans(blackish discolouration of skin in diabetics)and elevated fasting insulin levels favouring type 2 diabetes.
Currently you are placed on insulin to reduce the high blood glucose.
The further course of the MODY in your case depends upon the type of MODY who have 1/2/3? which is based on genetic evaluation of your diabetic genes GCK/HNF1A/HNF1B? respectively.
Type 1 does not need any further treatment,
Whereas type 2(can be made non progressive) needs oral drugs,
and type 3 needs complex management and is irreversible and progressive.
Post your further queries if any,
Thank you.
Genetic diabetes
Detailed Answer:
Hi Sir,
I have carefully read your query and understand your concern.
Going by your lab data the elevated uncontrolled blood glucose( as per elevated blood glucose and HB1ac) with normal fasting and postprandial insulin levels with normal fasting C peptide levels and elevated postprandial strongly point to a specific new form of diabetes which is neither type 1 nor type 2.
This is called Monogenic(Genetic) diabetes and MODY-Maturity onset diabetes mellitus of young in my opinion as 2 generations are affected.
Note:
1.Results should be confirmed only after genetic testing for the concerned genes for final diagnosis.
2.The current diagnosis is based only on the clinical and lab profile data.
This is characterised by atypical features of lack of insulin autoantibodies favouring type 1 or lack of insulin resistance features like acanthosis nigricans(blackish discolouration of skin in diabetics)and elevated fasting insulin levels favouring type 2 diabetes.
Currently you are placed on insulin to reduce the high blood glucose.
The further course of the MODY in your case depends upon the type of MODY who have 1/2/3? which is based on genetic evaluation of your diabetic genes GCK/HNF1A/HNF1B? respectively.
Type 1 does not need any further treatment,
Whereas type 2(can be made non progressive) needs oral drugs,
and type 3 needs complex management and is irreversible and progressive.
Post your further queries if any,
Thank you.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hello Sir,
Thank you for your answer.
For your information, as per the path reports, my pp Insuline level is elevated but my pp c-peptide is within range.
I have done above tests after 2 months of my diagnosis. So, my blood sugars are controlled at the time of tests because my hba1c after 2 months of diagnosis come 4.2 as I am on strict diet and Insuline theoropy. Still you will concider it mody?
Thank you for your answer.
For your information, as per the path reports, my pp Insuline level is elevated but my pp c-peptide is within range.
I have done above tests after 2 months of my diagnosis. So, my blood sugars are controlled at the time of tests because my hba1c after 2 months of diagnosis come 4.2 as I am on strict diet and Insuline theoropy. Still you will concider it mody?
Brief Answer:
Genetic testing is confirmative.
Detailed Answer:
Hi XXXXXXX
The cut off value for postprandial insulin levels as per standard reference values is 16-166 mIU/L. This standard cut off is taken after 2 hours. Hence your value of 71.66 falls within this range which is considered normal.
Like wise the 2 hour postprandial C peptide levels in adults is 2-4.5 ng/ml which in your case is 6.85 and that is elevated.
Since your Hb1ac levels have dropped from 11 to 4.2 with diet and insulin therapy, the consideration of MODY cannot be ruled out completely since as I already mentioned type 1 MODY is mildest of all which needs no specific treatment and which can be controlled through serial monitoring of Hb1ac.
Hence I strongly recommend you to have a genetic testing to Confirm the presence of MODY, since unique management is required later on.
Post your further queries if any,
Thank you.
Genetic testing is confirmative.
Detailed Answer:
Hi XXXXXXX
The cut off value for postprandial insulin levels as per standard reference values is 16-166 mIU/L. This standard cut off is taken after 2 hours. Hence your value of 71.66 falls within this range which is considered normal.
Like wise the 2 hour postprandial C peptide levels in adults is 2-4.5 ng/ml which in your case is 6.85 and that is elevated.
Since your Hb1ac levels have dropped from 11 to 4.2 with diet and insulin therapy, the consideration of MODY cannot be ruled out completely since as I already mentioned type 1 MODY is mildest of all which needs no specific treatment and which can be controlled through serial monitoring of Hb1ac.
Hence I strongly recommend you to have a genetic testing to Confirm the presence of MODY, since unique management is required later on.
Post your further queries if any,
Thank you.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hello sir,
Thanks again for detail study on my query.
I am confused because reference range provided by you and ref. Range of Lal path lab where I conducted these tests are different
Please confirm which one is more accurate.
I agree about genetic tests to be run to confirm. Still can you please verify reports I have uploaded for comparison. Please provide your valuable input.
Thanks again for detail study on my query.
I am confused because reference range provided by you and ref. Range of Lal path lab where I conducted these tests are different
Please confirm which one is more accurate.
I agree about genetic tests to be run to confirm. Still can you please verify reports I have uploaded for comparison. Please provide your valuable input.
Brief Answer:
Go ahead with the references i provided.
Detailed Answer:
Hi XXXXXXX
I understand your concern.
The values you provided cannot be taken as reference values due to large variations.
I advise you to go with the following values as standard normal reference values.These are more accurate.
fasting insulin levels: <25 mIU/L
2 hr postprandial levels: 16-166 mIU/L
Fasting C peptide levels : 0.4-2.1 ng/ml.
Postprandial C peptide levels: 2-4.5 ng/ml.
Post your further queries,if any
Thank you.
Go ahead with the references i provided.
Detailed Answer:
Hi XXXXXXX
I understand your concern.
The values you provided cannot be taken as reference values due to large variations.
I advise you to go with the following values as standard normal reference values.These are more accurate.
fasting insulin levels: <25 mIU/L
2 hr postprandial levels: 16-166 mIU/L
Fasting C peptide levels : 0.4-2.1 ng/ml.
Postprandial C peptide levels: 2-4.5 ng/ml.
Post your further queries,if any
Thank you.
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
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