Random glucose test – This is usually a fingerprick, or done while draining your arm/body of blood for other tests.  They test the amount of glucose (sugar) in your blood at the given moment.  Two random tests above 200 mg/dl is a diagnosis for diabetes.  That is kind of tricky for us with CFRD since illness is common and so is steroid use, which will give you higher than usual blood glucose levels.

C-Peptide test – I was told there is no real ability to measure the amount of insulin your body produces.  But when your body produces insulin it also produces a protein, c-peptide.  In theory if your body does not make enough insulin, you won’t make much c-peptide either.  Usually this means that your pancreas has given up the ghost and is no longer working properly.  I had this test done, as required to get insurance coverage (my crappy old policy) for my insulin pump.  Welllll… I failed the test… or did I pass it?? Turns out that my body makes enough c-peptide to qualify me as “normal” and not needing insulin.  Well… that is by far, not true.  The exact cause of CFRD is truely unknown to this date.  Of course our lil pancreases are on their way to complete self-distruction (which mine showed via a CT scan), but there is a study out there that claims the creation or use or something about the natural made insulin doesn’t work correctly.  Which is why I apparently have insulin dependent diabetes, but still have a normal amount of c-peptide (or at least I did last year).

Antibody test -  This is where Type 1 diabetics differ from all other types and exactly why CFRD is NOT Type 1 (although treatment is similar which is not to be confused with cause).  Type 1 diabetes is an autoimmune disease which is caused by antibodies that attack the insulin producing cells, the beta cells, in the pancreas.  If you have diabetes and have antibodies, you have Type 1.  If you have diabetes and do not have antibodies, you have a Type Other than Type 1.  A cure for “Type 1″ diabetes will not cure my diabetes and that is why I am such an advocate for the “Type Other”s.  It is possible for someone with CF to have Type 1, it is the same rate as for the “normal” population, but just because you have cystic fibrosis related diabetes and you are insulin dependent, this does not make you Type 1.

Urine Sugar tests – If you have too much sugar in your blood, it will spill over in your kidneys (which is not good) into your urine.  Usually one of the first tests they do when they suspect diabetes.

Liver function tests – For folks with CF our livers are at risk of damage from all the drug coctails we are required to take.  I am only mentioning this test because I know a few CF docs who try putting their CFRD patients on pills for treatment instead of insulin shots.  I guess pills are ok, but I would be hesitant because most diabetes pills have a high risk of causing liver issues…. Just one more thing I do not want to add to my list of things I need to deal with.

I am sure there are plenty of other tests I am not noting in this post.  Anyone else want to chime in?

side note: I have wondered since the extra glucose messes up the red blood cells, I wonder if it affects how oxygen, and how much of it, is carried through the blood stream (since it is also carried by the hemoglobin) which is kind of an issue for some of us cystics with messed up lungs.  I’m going to look more into that someday. But if I find that is true I am going to get even more pissed at the CF docs who put off CFRD testing (not mine luckily). *sigh*

Apparently a “normal” person would have an A1c level at about 5.0%.  My doctors suggest an A1c of 6.5% or a little lower, normal would be ideal, but that is darned hard to reach.  My docs find that above 6.5% it seems to really affect the CF lungs.  To me I really couldn’t understand what that number meant until I found a calculator online that could translate the number into something I was familiar seeing on my little meter tester thingy I use every day.  Here’s one I like, it goes both ways from A1c% to mg/dl.
http://www.accu-chek.com/us/rewrite/content/en_US/4.1.2:20/article/ACCM_general_article_2422.htm
Here’s a little chart on dLife:
http://www.dlife.com/dLife/do/ShowContent/blood_sugar_management/testing/a1c_conversion.html

154 mg/dl is the magic average number.  Personally, what I try to do is make sure I am at a safe, but lower number (preferably 85-95) through out the night since I am spending 8-9 hours at that level.  Recently with my Continuous Monitor I have found I am having a strange spike at 2:30-3am which means I am going to need to change my basal insulin rate at that time… but that is a whole different story.

Once last year I scored a 6.0% on my A1c test (yes, it went on the refrigerator)… I really doubt I am there again, it took a lot of hard work and discipline, but here is some tricks of how I did it…  Having a lower level for many hours while I am asleep made it easier to get to my goal A1c level.  When I spike at meals, I try to keep it under 200 mg/dl at the two hour mark by counting my carb intake as close as I can (IMPOSSIBLE when on evil evil prednisone), but I make corrections at the 2 hour mark if I have to (my pump figures out the calculation taking in consideration how much active insulin I already have in my system, which is why I am such an advocate of the pump, it does all the brainpower).  I have played with my numbers and found at my of 1 unit of insulin (which is an unbelievably small amount, it’s like a few drops!) for every 8 grams of carbs and my correction or sensitivity rate of 1 unit to 25 mg/dl (how much my bg number will drop with one unit of insulin), If I miss calculate my carb intake by 20 (two macroon cookies, who ever eats just two cookies?!) my blood sugar level will go up 62.5 points (mg/dl). HOLY!  That means I need to keep quite a close eye on things.  It never used to be that way when I was on shots, I was on a 1:15 ratio…. but then again, I was never in control of things on shots.

Back when I was out of control, my A1c level (at least the first one I really paid attention to) was 9.3%.  That number alone wasn’t enough to scare me.  But it should have.  The toll it took on my poor body was too much for it to handle and I have not escaped a few complications.  Nothing too scary, but annoying enough to get put on a few extra medications.  I wish I would have known then what I know now.

Just as I was starting to feel better from the freakin expensive medicine allergic reaction, my tonsils started to blow up again like one of those puffer fish. (geez! can’t I catch a break??!)  Back to the doctor I go.  Turns out I got ANOTHER weird bug I have never had before.  Luckily this one can be kicked by some cheep non-allergy inducing (fingers crossed) meds.  For an extra boost I agreed to do a boost of Prednisone (evil evil evil), which has given me some lovely roid rage, blood sugar numbers that go from normal to 450 in 30 minutes and a tummy monster that can not be tamed with no matter how much food I cram down.   I am afraid to say, go away bad juju, that I am starting to feel better FINALLY.

Do they not realize I have diabetes? My A1c at last check was 9.0, three months before that it was 9.3. A normal A1c is between 4% – 6%. I am already experiencing complications with my kidneys due to this and it affects my CF too. Do they not see the benefit of giving me a piece of equipment that will help lower these levels and prevent further damage and further complications???

Why does insurance seem to lack the skill of logic?