Fasting hyperglycemia and diabetes mellitus;
In clinical laboratory practice I had seen so many cases of type-II diabetes mellitus who gets a diagnosis of diabetes mellitus based upon raised fasting glucose but once u subject them with glucose load they easily manage there load. No doubt that fasting hyperglycemia is not not normal but i guess relying simply on fasting hyperglycemia, we may be overdoing the diagnosis part and in my personal opinion i feel w-hour postprandial glucose tolerance in an other wise healthy subject with any GIT pathology must be given to all subjects. Another thing which i have realized that once these subjects with fasting hyperglycemia reduce theri liver fat, they can overcome fasting hyperglycemia.
So fasting hyperglycemia and postprandial glucose tolerance are two varied concepts and the latter is a serious category. Then even thin, lean sometimes show poor glucose tolerance. And to me the latter category is worrisome rather than isolated fasting hyperglycemia.
So anybody wishes to comment on this? OR explain OR give some reasoning behind this?
Warm regards
Hi!
I recommend this :
Article Pathogenesis of Fasting and Postprandial Hyperglycemia in Ty...
Article Relation of fasting and postprandial and plasma glucose with...
https://doi.org/10.4158/EP15954.CO
Thanks a lot Khaled
This is an excellent article you share. It to me emphasized from the words used in the abstract
"I, as well as many other investigators, believe that such therapies are likely to be more effective and to have a lower risk than would occur if everyone were treated the same regardless of the underlying cause of their hyperglycemia"
So this clarifies 2 different stages and sometimes i guess patterns in the initial stages of the disease and thus need different therapeutic and life style approaches to management.
I guess you will agree that extra fat (NAFLD/NASH) along with glycogen reserve excess is the core cause of fasting hyperglycemia especially in subjects with underlying normal glucose load tolerance. This is the the start of life style mediated exuberant dietary intake with lack of utilization through exercise causing start of insulin resistance and the various effects have been mentioned in the article you shared.
Allowing this to progress will ultimately lead to full-blown insulin resistance where insulin (though)in excess will not be effective at end-receptor levels leading to poor glucose tolerance.
So again from the referenced article these two stages must be assessed to define which stage the beta cell dysfunction is, and treatment therefore needs to be taking these facts into consideration.
Again thanks Khaled for sharing this article.
Regards
Dr Sikandar
You can benefit from the following links.
1. Singh SK. Post-prandial hyperglycemia. Indian Journal of Endocrinology and Metabolism. 2012;16(Suppl 2):S245-S247. doi:10.4103/2230-8210.104051.
2. Haddadinezhad S, Ghazaleh N. Relation of fasting and postprandial and plasma glucose with hemoglobinA1c in diabetics. International Journal of Diabetes in Developing Countries. 2010;30(1):8-10. doi:10.4103/0973-3930.60002.
3. Hanefeld M1, Temelkova-Kurktschiev T.Control of post-prandial hyperglycemia--an essential part of good diabetes treatment and prevention of cardiovascular complications. Nutr Metab Cardiovasc Dis. 2002 Apr;12(2):98-107.
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