--as it will be a "fasting" level. Take it before he eats anything, and before he starts any exercise.

I agree with Mrs. D--his "informal test" numbers look a lot better. The initial spike was within a normal range for a half-hour. I'm glad you "caught" that 73, even if it was a little late. The fact that he had that drop from 1 to 1.75 hours does corrrespond to a little hypoglycemic reaction, but not one anywhere near large enough to cause symptoms. You'll notice over the next hour his blood sugar normalized to near his usual fasting readings--this is usually what happens to someone who has a bit of insulin resistance. To wit: the body responds to the glucose challenge, but it responds with a bit too much insulin than what's needed, so blood sugar gets driven down somewhat below fasting levels. (It's been speculated this happens due to the body having gotten used to pumping more insulin to drive sugar into resistant cells--that's the definition of insulin resistance.) Then, when the somewhat too low sugar level is detected by the body, the feedback mechanism turns off the insulin spigot, and blood sugar levels rise back to around their fasting levels.

People with insulin resistance of this kind--and considering Alan's previous weight and history, it's very likely he has a degree of it, though probably now well-controlled--often have slightly elevated fasting insulin levels, and it would be good to get that number. It's been estimated that the majority of us who are not ultradistance athletes--and maybe even some of them--get a degree of insulin resistance as we get older and our cells become less permeable. Part of the reason we're more prone to get that "middle-aged spread". With the standard American diet (yes, that high-fructose corn syrup is EVIL, like trans fats)--and the standard American couch-potatoism--it's a wonder we don't all have it. I think, though, with Alan's diet and exercise, he's arrested any progression towards diabetes; I really don't suspect that's what's going on. Now, he may have some nerve damage from earlier impaired glucose tolerance, which he may have had a degree of back when he was so much heavier. But, if I had to put my money on it, I would take a long look at those elevated IgG polyclonal immunoglbulins and the possibility of neuropathy secondary to cryoglobulins. You should mention this again to Dr. G (and you can tell her it came from me, if you want), as the spinal tap would not likely look specifically for this, though it would look for other autoimmune or infectious markers.