Since diabetes is defined primarily as hyperglycemia, its diagnosis, like prediabetes, depends on achieving blood sugar levels of a certain amount. As we have been discussing, the actual disease behind this, glucose dysregulation we're calling it, starts much earlier.
While the symptoms of glucose regulation do differ, for instance many people suffer from things like obesity, particularly in the belly area, high LDL, high triglycerides, and high blood pressure, these need not be present for one to get diabetes, even though a lot of diabetics do have these afflictions.
What type 2 diabetics do tend to have though is high insulin levels, and we know that the disease progresses from that to loss of blood sugar control. You will often hear this blamed on reduced insulin secretion, and while that does happen, insulin secretion at the point of diagnosis of diabetes tends to still be pathologically high.
Type 2 diabetes would be simpler to manage if that's all that was wrong, not that low insulin secretion is easy to manage, but at least we would be spared of the complications of ongoing high insulin levels as the disease gets worse and worse.
Of course we may create the same problems if we did have to use insulin replacement, as we very easily can overcompensate and create the same high insulin levels that caused the disease, if that were the case.
However, we do secrete too much insulin at this point and then we are eager to increase these levels even more, to try to keep up with escalating levels of insulin resistance and hepatic glucose output, all made worse by hyperinsulinemia, so this ends up being a vicious circle, although one that progresses slowly enough that we may be lulled into a sense of security by seeing fairly good control, only to lose our grip on this as the years go on.
Diabetes really needs to be managed from a lifetime perspective, to not just worry about how our next quarterly A1C is going to be, but to worry about the A1C's far down the road as well, as they will be coming up and if we aren't acting in both our short and long term interests than we are being too myopic and will pay the price for that sooner or later.
However, right now we are at the door that enters to the land of diabetes, and that's a door that they say we can never go back through. Once a diabetic, always a diabetic they say, although oddly enough, given that this disease is defined purely by high blood sugar, getting rid of the high blood sugar, even long term, doesn't entitle you to no longer call yourself a diabetic, at least in the minds of a great many people.
Whether that's true or reasonable or not is another matter that we will leave for another day. If you are currently in the diabetic zone we'll call it, and for simplicity's sake we'll say A1C of 6.5 or higher, the standard that is accepted, this does mean that you definitely need to be paying attention to your blood sugar and for the rest of your life actually.
People by the way should be paying a lot more attention to their blood sugar than they do, which is pretty much none, and if you asked for a meter and strips at a pharmacy and told them you didn't have high blood sugar they probably would think you are crazy.
If you asked your doctor for a prescription for this stuff, you'd really be seen as crazy, they don't want you measuring your blood sugar much even if you do have diabetes, so if you don't, forget about it.
Everyone should have their blood sugar tested regularly though, and we're only taking once in a while if you are fine but once in a while is required if you are to stay on top of this. I'd also strongly recommend people ask to get their insulin levels tested once in a while as well, and especially insulin levels, since this allows us to detect problems many years before blood sugar even starts moving toward the prediabetic range.
Fasting blood glucose levels and an oral glucose tolerance test (OGTT) are also used to diagnose diabetes, and while you may not want to go for the OGTT, which isn't all that pleasant they say, you should have both your fasting glucose levels, over a few days at least, and an A1C test to be diagnosed.
Doctors tend to really prefer A1Cs anyway, although there are some things that can interfere with this test such as anemia that may not make it as reliable as it needs to be, so a second test like the fasting glucose test, where you're looking for a fasting reading of 130 or 7, depending on the scale that's used where you live, or even an OGTT, where a blood sugar level of over 200 or over 11.1 indicates full blown diabetes.
All of these tests can also be used to diagnose prediabetes, high blood sugar or a lesser variety that still needs to be taken seriously, or to just see where you are at, and the closer you are to prediabetes the more concerned you need to be. We could call this preconcern perhaps, but any blood sugar reading that is higher than normal deserves some concern, and there's nothing pre about higher blood sugar because it's happening right now.