[Alkymst]

I know that this is not a diabetes forum and that there have been numerous posts already about the oral glucose tolerance test (OGTT) and peripheral neuropathy but I want to add another - hopefully this is not a repeat of something recent and clutters up the boards.

In any case last year Peter Bosch's group at the Mayo clinic in AZ published a study that futher confirms the link between abnormal glucose metabolism and chronic idiopathic axonal polyneuropathy (CIAP), something with which many on the board have first hand experience, myself included. The authors showed, as have others, that the OGTT is a much more reliable and accurate prediction for CAIP than fasting plasma glucose. They found a 2-fold higher diagnostic correlation using OGTT. In addition, the diagnostic accuracy was virtually the same for pure sensory, sensorimotor, and small-fiber PN's associated with CIAP and correlate well w/ the revised criteria from the ADA.

The authors also noted that in their particular study group of 100 patients that while the neurologic deficits were relatively mild, all patients were sensory symptomatic and the vast majority were in pain (82%) - this contrasts with some other studies where painful PN was more often associated with CIAP related to impaired glucose tolerance.

Doesn't really matter though - pain is pain is pain, regardless of the source.

The link follows: http://archneur.ama-assn.org/cgi/content/full/63/8/1075

Alkymst

[rose]

Not a diabetes forum, but that information is certainly relevant. More information is never something to apologize for.

rose

[Brian]

This is important information for any Idopathic PN'er and especially any neuro that doesn't bother to do a Glucose Tolerance Test to their patient and only relies on a normal blood test for diabetes, this really surprised me in that, i would have thought every test known for PN would have been done before they slap the word idopathic onto their patients, especially diabetes being the most common cause of PN.
My neuro sent me for a 3 hour glucose tolerance test on the very first visit to him, which fortunately the cause was found, first up " prediabetes ".
Anyway thanks for sharing the info.

Brian

[Kathi49]

Ditto that Brian!!! I find the information VERY relevant...and as you say...for anyone with an "idiopathic" diagnosis. Just want to add...a GTT was one of the first things I had done by my Neurologist. As it turns out, no, not prediabetic.

[dahlek]

an overlooked point! The 3 hr GTT was THE last test I had....
Tho if you look up some prior posts by Nide44/BobB...you will find that he's an advocate of the 5-7 hour tests...I agree wholly as I'd been thru an 8 hour test eons ago that only showed a hypoglycemic reaction at the last two hours.
Both glycemic and hypoglycemic reactions can and do mimic each other they are soo close as to be mis-diagnosed or overlooked.
For all tho...checking out they whole endocrine system is not a bad idea either... all sorts of things can set the 'wheels' so to speak into motion. Ask anyone who has had Graves or Hashimoto's issues [as I recently learned]. Testing is CHEAP compared to potential long term damages?
These things...all these things can overlap and confuse any base or complex issues and are not all tested at key times to be 'ruled out' at those key times. Hindsight doesn't cut it in my book, once the damage is done.

BTW HOW are you doing? You've been quiet about that of late... Status quo?
Super good thoughts all the time! - j

[glenntaj]

--which is yearly at this point--I request that the scrip be written that it be a five hour test with glucose AND concurrent insulin levels taken at baseline, one-half hour, 1 hour, 1.5 hours, 2 hours, 2.5 hours, 3 hours, etc.

Yes, I do feel like a pincushion, but I'm used to it at this point.

The reasoning behind this is one not only want s to see how the glucsoe levels rise and fall, but how insulin levels do, too. The pattern of inmsulin increase to raised blood glucose--and how far down the glucose levels are driven by insulin spiking--are important clues to the degree of insulin resistance one has, and insulin resistance is the first harbinger of impaired tolerance.

I generally show a fairly normal blood sugar rise to the glucose beverage, but my pancreas tends to overreact to it with a big release of insulin, which tends to drive my blood sugar down fairly low--into the 60's--around the 2-3 hour area. The insulin then recedes and I stabilize to a fasting level in the high 80's - low 90's in the fourth-fifth hours. This is a fairly common pattern in those of us insuin resitant--wide swings. This is not a good thing.

I suspect if it were not for the weightlifting and R-lipoic acid, my fasting glucose would be higher. I am endeavoring to fight off impaired tolerance through diet (eating small balanced meals fairly frequently), exercise (lot of swimming this summer) and supplements. (I do take some of Mrs. D's recommended inositol, but am wondering if it's time for cinnamon or chormium supplements to be added--both have demonstrable glucose normalizing properties. Unfortunately, you're supposed to take the cinnamon without the added sugar.)