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Family Medicine  (Expert Forum)
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Blood Sugar
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD Boston - MA
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
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MedHelp Member's Question

Blood Sugar

by Jigger26, Mar 22, 2004 12:00AM
I'm a 34 year old, white male. I'm 6'4 and 185 lbs. I'm athletic. Played baseball at The University of Tennessee and have been a avid jogger for 18 years. I still log 6-8 miles per day. My diet has been poor for years, and I used to be a heavy beer drinker. But for the last two years I have payed special attention to my diet and do not drink any thing alcoholic. My concerns are two things. First is my cholesterol. My total runs adout 155-160. But my HDL is only 35-40. Shouldn't it be higher? My internist, who is my best friend says it is genetic. My other family members also have lower HDL levels. But no heart problems.

I worry that my liver might be damaged from years of drinking. But my liver functions are all perfect. My second worry is my fasting glucose. I have had it done 5 times in the last year and it has been 98,104,94,98,103. The new American Diabeties range says 100-126 is pre-diabeties and that pre-diabeties becomes full blown Type 2 within a decade. My internist says that my numbers are not that bad and that obesity causes most of those folks to become type 2. I'm far from obese. I run 45-50 miles weekly. And will continue to the rest of my life, God willing. My father is a type 2 diabetic and I realize that is a risk factor. I guess it boils down to the fact that I'm worried my liver or pancreas might not be up to par due to my youthful partying. All other lab work is great. Blood Pressure 110/65. Iron levels are good. We suspect my dad has Hemochromatosis. In your opinion can I prevent Type 2 by my healthy lifestyle? Or at least delay it for many years? Also my HDL seems to be going up since I stopped high carbs and trans fats. Could it be lower because of genetics. My aunts is only 36. My moms is 41. They are both very healthy otherwise. Also, my trygkycerides remain below 70. So, I probably do not have the insulin resistance factor.  THANKS, JEFF
Doctor's Answer

by Kevin Pho, MD, Mar 23, 2004 12:00AM
Yes, you can prevent type 2 diabetes through a healthy lifestyle.  Maintaining appropriate weight is of utmost importance.  Regarding your fasting levels, impaired glucose tolerance was recently changed to 100-126, so you are right on the border.  I would suggest monitoring your fasting sugars on a regular basis.  



Regarding the HDL, typically we like it above 40.  Increased exercise typically raises it, but since you run 45-50 miles weekly, there are genetic factors that might be in play here.  With a total cholesterol of less than 200 and triglycerides below 70, the rest of your panel is normal.  



I would continuing following up with your primary care physician to monitor some of these levels (i.e. HDL and fasting glucose).  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.
Member Comments (2)

by ontherecord, Mar 24, 2004 12:00AM
To: jogger
My friend, you raise an excellent question.  The current thinking in modern medicine is that obesity is the #1 risk factor for Type II diabetes.  This obvioulsy does not apply to you.  Therefore, at the very least, if you keep up your current exercise regimen, you can pre-empt or prevent the onset of Type 2 diabetes altogether.  In addition, exercise does increase HDL levels but does nothing to reduce LDL levels. LDL levels are managed by diet; keep your saturated fats DOWN as far as possible: avoid cookies, red meat, and any other foods high in saturated fat.  All this said, there is a genetic influence and correlation as far as type 2 diabetes goes.  But there's nothing you can do about that, so control what you can.  Keep up the exercise, minimize saturated far intake.  As far as the glucose levels, anything under 100 is ideal.  If you're fasting glucose is under 100, you minimize your risk as far as type 2 diabetes goes, notwithstanding the guidelines. 103 is insignificant as far as I am concerned.  It's looking good for you.  You didn't  mention your LDL which is actually significant.  Also figure out your total ratio which is your total cholesterol divided by your HDL.  This is very telling.  Also, moderate alcohol is known to raise HDL by up to 10% so ask your internist about that.  



Bottom line: the way you're going, it is looking pretty good.  Keep it up and control the risk factors you can.  



best of luck to you.

by Jigger26, Mar 25, 2004 12:00AM
To: ontherecord
My LDL is 99. My HDL to LDL ratio is 3.2. And my total to HDL is  4.7. My HDL just seems to be genetics. If my glucose was causing a problem with it my tryglycerides would be higher. They range from 50-72. I have started 1 glass of red wine per night. Does fasting blood sugar increase with age. I have read that it only goes 1 to 2 mg/dl per decade. Is it possible for a fasting blood sugar to elevate from anxiety in the doctors office. My blood pressure can. It has gone from 140/70 to 110/58 in just five minutes at the clinic. I hate the doctors office. Even though my best friend is my internist, I get torqued out big time. JEFF

by ontherecord, Mar 25, 2004 12:00AM
To: jigger
Total cholesterol of 155-160 with LDL levels of 99 sound perfect to me.  Yes, the HDL is a little low, but if you're exercising regularly and drinking that one glass of wine nightly, there is not much else you can do about it.  



You may want to add a multivitamin to your regimen, one with sufficient B-complex.  Even though you do not drink heavily nowadays, many problems that are associated with drinking result from nutritional deficiencies, especially deficiencies in B-complex vitamins.  Like I said, it definitely can't hurt to add that into the mix even if you no longer drink heavily.



Blood pressure can vary in as little as 5 minutes.  How you feel, what you ate, whether you just walked up 3 flights of stairs -- all that stuff affects BP.  Your readings are normal.



by Jigger26, Mar 25, 2004 12:00AM
To: ontherecord
i think my HDL is on the way up. Last Nonvember I had my first lipid panel run in about 10 years. Check out these numbers. Total 241. LDL 198. HDL 34. Tryglycerides 51. I was on a very heavy saturated and trans fat diet, with lots of bad carbs!!! I went on a silly crash diet for about 2 weeks and my Toatl dropped to 142. In only 2 weeks!!  However my HDL plumeted to 28. I have always done my exercise for most of my life. My diet was just terrible for many years. I kept my weight in check by running 6-8 miles 6 days a week. I began losing weight rapidly once I got on a good healthy diet. I was 230 lbs in November, I'm now 192 lbs. I had my lipids checked about 6 weeks ago in Febuary and they were as follows-Total 160  HDL 35  LDL 108  and VLDL 14. My tryglcerides were 71. Not horrible. So, anyway hopefully my HDL was down due to diet and is on the rise. My nutritionist friend says to be patient that HDL goes up much slower than LDL moves up or down. Do you think I can lower my fasting glucose or just mauntain it. I take vitamins and garlic and magnesium. JEFF
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