is it possible to have high blood sugar and not have diabetes?

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November 09, 2005

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Question

It seems like the ADA guidelines are very quick to label people as having diabetes. This concerns me from both a medical and financial perspective. I have not yet purchased long term care insurance, and I don't want it said that I have diabetes if I do not. From some reading and research, I think my problem might be with my adrenal glands secreting too much cortisol. I have been under a lot of stress during the last three years and recently decided to retire early. My last three HbA1c levels have been 6.5, 6.3, and 6.1%. During the time before the last test (6.1%), I had a cortisone shot for a rotator cuff tear.

I thought that taking the glucose tolerance test might be more definitive. However, the lab at my HMO requires that anyone taking the OGTT has to eat three slices of bread with every meal for the three days prior to the test (27 slices of bread) and then fast the night before. I checked with other labs, and they do not require the carb load. I checked with the Health Educator at my insurance company and they follow the guidelines of the Health Wise Knowledge Base, which are also posted on the Internet. Those guidelines instruct a person to eat balanced meals for three days prior to the OGTT, and each of the 3 days prior to the test should include 150-200 grams of carb.

I canceled my OGTT because I wanted to get more information. I thought the OGTT was a standardized test and assumed that there would be a standardized protocol for preparation. Do you have any suggestions for how I could/should proceed? Is it possible for someone to have high blood sugar readings and not have diabetes? If so, how can a person determine the reason for the high blood sugar?

Answer

All of the A1c levels you cite appear to be above the normal range for most labs. While the cortisone injection may have caused some transient elevation in your glucose levels, keep in mind that the A1c reflects an average over a period of about three months. Therefore, it is doubtful this was the cause. The same holds true for the stress you mention.

You are quite correct when you say that a GTT is more definitive. While not needed for diagnosis, it continues to be the "gold standard" (see diagnosis of diabetes). It is standard procedure to carb load for three days prior to the test in order to achieve accurate results. So, the folks at your HMO are performing the GTT properly, while the other labs you contacted may not be.