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12/26/2012    Steven D Epstein, DPM

Definition of Diabetic (Charles Morelli, DPM)

I look at it another way. A few years ago, I was
diagnosed as "pre-diabetic". That meant my
hemoglobin a1c had reached 6.5. So I watched my
weight and diet, and by diet alone, got it down
to 5.6. But over the next several years, it
crept back up, and at one visit, my a1c hit 7.0.
So, then I was officially diabetic, despite the
fact that I would go on, again with diet alone,
to get it to drop below 6.0. Most recently, it
was 6.6. I'm "watching" myself again, but from
my glucometer I can tell that, if anything, the
next a1c will be higher, not lower.

Remember that thing about increased insulin
resistance? And about glyconeogenesis by the
liver at night because in diabetes, when you're
not eating, the body thinks you're starving and
tells the liver to make glucose?

Nevertheless, I proudly puffed to a neurologist
friend about my amazing ability to control my
NIDDM by diet alone for nearly four years now,
i.e., my ability to keep the a1c under 7. She
looked at me coldly and told me she regularly
puts diabetics with a1c's of 6.5 on Metformin --
when she's seeing them for a stroke.

There is really no such thing as "pre-diabetic",
and the a1c and fasting bs thresholds keep
getting lower and lower. If anything, our
patients underestimate the severity of their
disease. The fact that someone was on meds and
isn't anymore doesn't mean they're no longer
diabetic. It means that for the moment, they did
enough with diet and exercise to bring their
sugars down to the point where the meds are no
longer necessary -- for the moment. But they
will be again, and even if not, diabetes is a
disease, as we podiatrists all know, and not
just a blood sugar level. Dr. Morelli, I
consider all those patients to be diabetic.

Steven D Epstein, DPM, Lebanon, PA,

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