Diabetes Q&A: Normal and Target Lab Values; Life; What to Eat; What Meds for T2D

1) What does an elevated bilirubin number mean?

Bilirubin is a yellow-colored substance that is formed as a result of the destruction of old red blood cells. The amount of “bili” can be measured in the blood. The usual cause of excess bilirubin is liver disease, although some forms of anemia can also cause high levels in the blood. These conditions have other lab abnormalities that help distinguish what kind of disorder is present. And there’s a harmless condition called Gilbert’s syndrome, where bilirubin levels are intermittently elevated in people with no other disease. If there’s a considerable excess amount of bilirubin present, the skin and whites of the eyes will turn a yellowish color, which is called jaundice. However, there’s no particular relationship of elevated bilirubin with diabetes.

2.) Can you explain what day to day life is like for a person with type 1 diabetes?

One could write a book about life with type 1 diabetes (T1D) - and many people have! Life with T1D is different for every individual, depending on one’s innate personality, the quality of medical care that’s provided, the age of the individual, and other factors. The basic facts-of-life for folks with T1D, to my way of thinking, are (1) the necessity to take insulin by injection or insulin pump on a daily basis, (2) the risk of overtreatment with insulin, which may result in low blood sugar (hypoglycemia), (3) the need for awareness of the actions of food on changing blood glucose levels (BGL), (4) the need to check BGLs regularly, and (5) the concern of future complications if BGLs are not controlled to normal or near-normal levels. But diabetes doesn’t stop folks with T1D from doing what they want: some are professional athletes, others may be doctors or nurses, and most are everyday people like you and me. (There’s a partial list of some famous people with T1D at Wikipedia.)

3.) The diabetes numbers game has me wondering whether or not “one size (target number) fits all?” Before I developed diabetes, I occasionally used my mother’s meter to check my blood sugar, and found that I was feeling hypoglycemic whenever the reading was 105 or less. All my life I easily tended toward hypoglycemia, so even now I don’t dare let my blood sugar get anywhere near the recommended 85. Thoughts?

Target numbers are different from normal range numbers. For blood glucose, a normal value when fasting for someone without diabetes would be about 70-99 mg/dL (3.9-5.5 mmol/L). Diabetes is present if fasting blood glucose levels (BGLs) are greater than 126 (7.0 mmol/L) or random BGLs are over 200 (11.1 mmol/L).

For people with diabetes (PWD), BGLs of differing levels are recommended for different circumstances. Although lots of diabetes organizations have set their own recommendations for acceptable BGLs, the recommendations should be individualized for different circumstances: for example, target levels recommended for pregnant diabetic women are lower that the levels most non-pregnant folks might use. And for newly-diagnosed PWD, who might have BGLs way higher than normal, temporary targets that are between where they are and where normal values are, would be reasonable for starters.

But you describe a different situation: you are concerned that you are having symptoms when your BGL is normal. That’s not a common situation, and I’d really want to know that your BGL has been measured in a lab at a time you have symptoms, and I’d want to know whether the symptoms that you have match the classic ones for hypoglycemia. Be sure to discuss this with your diabetes doctor, or diabetes nurse educator. And you might benefit from having CGM for several days, to see the trends of what your BGL are doing before you develop the symptoms.

4.) I am 42 and recently diagnosed with type 2 diabetes. I have a myriad of other things against me, such as gluten intolerance, lactose intolerance, living with fibromyalgia and PMR, and suffer with weight gain issues. There are conflicting views on what I should and should not eat, and I don’t know what is truth or fiction. Can someone please tell me what I can or can’t eat, and what I should be and should not be eating? It’s very frustrating not to have clear guidance.

Of course, anyone can tell you what you should eat (and probably your well-meaning friends and family already are advising you!). But I’d really prefer that folks with difficult situations like you describe should be evaluated and advised by a diabetes dietitian, preferably one with the Certified Diabetes Educator (CDE) credential. If your physician or diabetes nurse don’t know one, you can search on-line at Find a CDE.

5.) I have type 2 diabetes, weigh 117 pounds and I’m 5 ½ feet tall - how many carbs per meal would be good for me? I try to eat low-carb, lots of vegetables, very little starches like potatoes, ride or white bread, and I exercise regularly. What should my A1C levels be?

Two separate questions here. First, how many carbs per meal should you eat: it would depend on how active you are, and how close you are to your target BGLs. If you are eating low-carb, be aware of pitfalls such as those mentioned in Top 8 Low-Carb Mistakes.

Second, what should your A1C level be: like BGLs, the recommendations for A1C should be individualized. Most diabetes authorities suggest PWD should have an A1C below 7.0, or below 6.5, or “the lower the better” but of course, lower A1C levels may be associated with increased risk of hypoglycemia, so talk to your diabetes doctor or diabetes nurse educator about what level would be appropriate for you to achieve.

6.) What are the A1C guidelines for people without diabetes?

If you don’t have diabetes, your A1C level should be within the range of whatever the lab says is normal. That is based on the assumption that the laboratory is using a version of the A1C test that has been validated in a “normal” (non-diabetic) population. For people without diabetes, the normal range for the hemoglobin A1c test in most labs is usually somewhere between 4% and 5.7%.

Values over 7.0 indicate diabetes; values in the range of 5.7 to 7.0 are now called pre-diabetes. I should also add that for many folks with diabetes, the target for their A1C should be in the normal range - but there are exceptions: see my previous essay, A1C Levels for Truck Drivers.

7.) I have type 2 diabetes and take two different pills plus an injection of insulin. I know several people with type 2 and they only take one kind of medication. I think it’s ridiculous for me to have to take so many medications. I hate needles so I wanted to discuss GLP-1 medications with my doctor. What would you recommend?

Well, if your physician hasn’t already discussed the possibility of you taking a GLP-1 agonist, you should raise the question with him or her! Several of the GLP-1 agonists are once-weekly injections, and the rest are daily. It’s possible that using one of them might replace one or more of your present pharmaceuticals, and simplify your medication program. It’s also possible that a once-weekly injection of a GLP-1 agonist might replace your daily injections of insulin -- but I really wouldn’t bank on that.

And IMHO, it’s not ridiculous to be on multiple drugs for diabetes: How to control the BGLs in type 2 diabetes is a balancing act between cost, convenience, effectiveness, and the risk of side effects. If your physician isn’t comfortable with helping you to adjust your diabetes medications, you should ask for a consultation with an experienced diabetes doctor.