Glucose Tolerance Test Result
 

Dear Mrs. D,
You said once I have my Glucose Tolerance Test result, I should post it so you can compare with your graph. (I am sorry, I could not stay long on the computer to look for your post to quote because I feel dizzy.)

I got it today and here it is (it looks within the normal range):

Glucose, Fasting : 87 (normal range : 65 - 99 )
Glucose, 1/2 hour: 129 (normal range: 65 - 199)
Glucose, 1 hour : 101 (normal range: 65 - 199)
Glucose, 2 hours : 71 (normal range: 65 - 139)

Well, I am thankful that its normal. One step forward to a long journey....

I had my skin biopsy today. I was not given antibiotic which is good. I dont want to be taking antibiotic, anyway.

Thank you as always.

I think 71 at 2 hrs is quite low. A reactive low.
http://hypoglykemie.nl/gtt.htm
Not true hypoglycemia yet, but close. It would be helpful to have
fasting insulin run. When there are reactive lows, that suggests insulin excess. This may precede diabetes by several years, but can imply
impaired glucose utilization. Lows are starving nerves just like highs are.

While doctors look for highs, they ignore lows.
So while you are "normal" for diabetes, your lows, which might be more revealing on a longer test... are indicative of a possible reactive hypo state.

I second that--
 

--and would highly recommend a much longer glucose tolerance test, with both glucose and insulin levels determined with each draw, to see the patterns.

Specifically, as Mrs. D says, you would want to know your fasting insulin level, to see if it is relatively high (that may be what is keeping your fasting glucose in a normal range, and it may signal insulin resistance, in which the body has to produce more insulin to keep blood sugar in check). Then, you would want half hour draws until at least 4 hours to watch the pattern of insulin and glucose rises/falls. What often happens in the insulin resistant is that their blood glucose does not rise that much in the first hour and a half or so as the body reacts to the glucose challenge by producing a big spike of insulin--this spike, however, tends to drive glucose levels down below one's fasting level in hours two/three (which may be happening here) until first insulin and then glucose "normalize" in hours three and four.

This pattern of "reactive hypoglycemia" is quite common among the insulin resistant.

Also I should add. When I was hypothyroid and undiagnosed, my fasting glucose was usually below 80 and often 70.

When my thyroid was treated, it rose to 85-90. I haven't had a 70 in YEARS now, and in fact my fasting is now over 100 regularly. :rolleyes: This is the progression of insulin resistance over time.

Dear Mrs. D,
I have had Glucose serum test last May and November 2011 and the results were 97 and 87, respectively. I am not sure if this is thesame as the fasting blood sugar. The tests were part of the Metabolic. Panel Test. Again, in June 2011, I had another glucose serum test but this time I did not fast as the blood extraction was done at the doctor's clinic - result was 98.

Are the numbers indicative of a reactive hypoglycemia?

Is hemoglobin a1c a good test to determine if one is a reactive hypoglycemic or is this only to determine the average sugar in the blood for diabetic?

Thank you Mrs D for helping all of us.

Hi Glenntaj,

Thank you for your ideas.
I will have to consider taking a longer glucose tolerance test. However, I showed the copy of the result to my endocrinologist during my visit (the request for the test came from the. Neurologists) and he said everything is normal.


I don't know how to justify to the endocrinologist the additional test.

Assuming I am in the threshold of being a reactive hypoglycemic, can this be corrected with frequent small meal and no medicines?

Thank you.

There is no medicine for hypoglycemia -- well there was one, long ago that ended up to too toxic to use: ProGlycem. You see hypoglycemia was a "disease" back in the 70's. It was an epidemic actually. What it really was ... is an indicator of impaired glucose utilization, that has now become diabetes for many.

Not all doctors attend to lows predictably. They are only looking for the dreading diabetic highs. But the lows are a message, a HEADS UP, to change your ways. Avoid sugar, high fructose corn syrup, and heavy reliance on starchy carbs. Smaller meals, and some good nutritious snacks twice a day or so, help even out swings in blood sugar. Keep in mind when LOW your cells are not getting the glucose they need.

The HbA1C is for targeting high blood sugars after eating. With your rather depressed results I would think your HbA1C would be normal, or on the low side.

Dear Mrs. D,
I will take note of your advice on what food to avoid.

Thank you so much.

Idiopathic

I would like to raise some clarifications on the results of my husband.

My husband has not been on medication for blood sugar.

His blood sugar has always been less than 7 (but more than 6 - just forgot the exact number) on fasting blood sugar and Hemoglobin AIc. On my insistence, he asked our PCP during his annual physical examination to give him the glucose test (I suggested to be more than 2 hours - as recommended in this forum). However, the PCP only has 2-hour Glucose Test in their computer system. The results are as follows:

Glucose, Fasting - 103 (65-99) High
Glucose, 1/2 hour - 161 (65-199)
Glucose, 1 hour - 119 (65-199)
Glucose, 2 hour - 108 (65-139)

A medical staff called him advising him that there is no need to see the doctor since his 2-hour glucose test is normal.
It appears he is pre-diabetic, but I need confirmation from those who understand the test better.

Thank you.

If his A1C is over 6.5... I'd put him on a low carb diet for awhile.

I think he is borderline. Sometimes just some diet can help this.
Size of meals, etc can make a difference in the A1C.

Just keep an eye on him.

What is good with him is his discipline to exercise. He has sweet tooth but can restrain himself. I always tell him one PN in the family is enough.

I think his AIc was 6.5.
Thank you Mrs.D:hug:

That really shouldn't matter. I just got tested for 2 things that weren't in the "system"; the doctor just writes in the tests by hand and the lab sends them out to be done elsewhere. It takes a few extra days to get results.

It's possible your PCP had some other reason for not feeling the longer test was necesary/warranted(?)

Doc

Well, I also experienced one time when my endocrinologist just wrote on his prescription pad the request for my bloodwork.

Thank you.

I agree with Dr. Smith--
 

--they certainly could order a longer glucose tolerance with several more draws and with insulin levels concurrently measured, which I think might provide more insight.

I suspect he is borderline. The A1c test is useful in that it provides an average of glycated hemoglobin over an eight-to-twelve week period, but one does not know if these averages come from a relatively uniform level of glucose in the bloodstream or from significant peaks coupled with significant lows. The longer glucose tolerance test with concurrent insulin levels is better at seeing this--one can see how one's insulin levels are at baseline, how they respond to the glucose ingestion, and how long the cycles are.

A fairly common finding as people get older is fairly "normal" glucose levels to start, but somewhat elevated insulin levels needed to keep those glucose levels, and an overproduction of insulin upon challenge to keep glucose levels out of diabetic ranges. Sometimes the glucose spike is so big that a reactive hypoglycemia occurs in the second/third/fourth hour. This is often referred to as "insulin resistance" and indicates difficulty getting glucose into the cells; this is often a harbinger of future diabetes. Muscle building is often a way to combat this--muscle on the whole is less difficult for insulin to drive glucose into. (And, of course, losing fat helps.)

Thank you Glenntaj. I will definitely share your message with my husband.

I am sure it will take a long time and for good reason for him to take another glucose test (he got "traumatized" as his arms were both black and blue after the extraction - even now).

He will have to observe his diet even more. He actually been observing the less carbo due to his triglycerides. He is taking Tricor or sometimes the generic version.

Yes, glucose tolerance tests can be awful for people with thin or deep veins!

He might want to get an RX for a glucometer and strips...to monitor what foods control him better. It can be helpful to manage the dietary habits.

I favor One Touch. You can get a free meter, but strips are separate. Its chemical system is less prone to false high readings. Strips on RX are paid for by most insurances and medicare.

He has thin veins. He was very hydrated the day before the test but still it was an experience for him!!

Thank you MRs.D for your suggestion:hug:

For what is is worth, Tricor did not affect my triglycerides any more than fish oil did. I was at 512 originally, doctor freaked out and put me on Tricor. This was about six months before I was diagnosed with PN. Pain levels and disability really escalated and my neurologist advised I stop taking it. It is toxic for CMT and a lot of neuropathies.

Tricor only brought my levels down to 350, fish oil, walking, and weight loss have been more effective, low carb, etc. levels staying around 300, but i have bigger issues with the CMT, so don't actually care too much. There is some evidence that sugar really imacts triglycerides, so I try to watch that, but I love sweets and fall off the wagon sometimes. GTT has been normal.

There is something called hereditary high triglycerides which seems to be benign, also there was a study linking high triglycerides to PN in a British medical journal some time ago.

Even though your husband doesn't have PN I would keep an eye on the Tricor side effects list. I think it can be a dangerous and not particularly effective drug.

Thank you Susanne for chiming in. I appreciate it.

He has been on Tricor (and Nexium) for years. It seems that Tricor is working for him since his triglyceridess been normal.He is being monitored for it every 3 months just as his blood sugar, kidney and liver functions.

He exercise 5x a week and observe carbs, BUT he loves sweets. He would indulge himself on weekends with some sweets as his "rewards/gifts".

I put him on VitB12 because he feels some little burning in his feet every once in awhile. So, I remind him always of how critical to maintain his blood sugar. I always tell him, one PN in the family is enough.

Nexium will deplete B12, folate, iron, calcium, magnesium and
zinc absorption.

I'd put him on magnesium too. Diabetics lose magnesium in the urine, and he is borderline. Males should not supplement iron, unless a doctor suggests it from tests.

He might also benefit from whey protein shakes. Nexium impairs protein digestion, and hence protein may become low in people using it long term. Whey protein is predigested and assimilated as amino acids. This may help the A1C.

That could be the result of a less experienced phlebotomist (blood draw technician, vampire). I have extremely deep veins; they can't use my elbows anymore, so draws are usually from my hands, and I've had similar experiences to your husband's when the new kids are drawing my blood. Now I ask for specific techs I know, or if not available, the most experienced they have. It can make a HUGE difference in the whole experience, from the needle jab to after-bruising/hemorrhaging.

Doc

Yes, Doc Smith, we will definitely ask for the most experienced technician in his next glucose test, if ever he agrees to it again. :D

Hi Mrs. D,
I am trying to open the link you gave me months back but I cannot open it now.

You mentioned before that I could be reactive hypo and this may precede diabetes...guess what, I am having trouble with my sugar now. I am still good with fast blood sugar but sugar shoots up after meal (which is normal) but it goes back to normal level very slowly after meal. So, i was trying to go back to the link to see where I stand with my glucose hours after meal.

I monitor my glucose now to see what food and how much of anything make the blood sugar shoots up.

Btw, I still take R-Lipoic (among others the supplements listed in your recommendations). I am hoping that R-Lipoic will help stabilize my sugar.

Mrs.D, could there be some medications or supplements that may have triggered my abnormal sugar. There is no diabetic among my family members. I still eat same food, in fact, healthier food since I was diagnosed with my diseases.

I hope you are getting better each day.

Mary

This link is a copy of the first one...

It still works:
http://www.rajeun.net/gtt.html

That link disappears, and reappears...that I gave before.
It comes from Europe. This is the second time the link failed...
they must have moved it.

I'll have to find it again...sorry.

The A1C is a better predictor over time... Do you know your current A1C?

Let me think about this, in the meantime.
Stress, stimulates the adrenals, and they make cortisol which will elevate sugars. Infections also elevate sugars. So does physical activity.

Mrs D, I thought activity and exercise lowered sugar level.

here is another link with the tables at least.

http://www.dsolve.com/news-aamp-info...ce-information

When a person does heavy exercise and then takes their sugars, they may be high. This is because of the cortisol effect and rapid conversion of glycogen that is stored.

They will then go down, in a while if that person is normal.

If a person is prediabetic the sugars can go up to 400 or more!

More explanation here:
http://www.diabetesdaily.com/forum/a...-blood-glucose

Overall on a daily basis in moderation, there is not much effect.


But when exercise is heavy, there will be a brief rise.

Thank you Mrs.D for your usual quick reply.
My last AIC (as of Oct 2012) was 5.6. The endoc was not concerned abouot it. However, I have blood works done to monitor the effects of my medication every 2 weeks and the the glucose serum is part of the test. I take the test randomly e.g. with fasting or 1 hour or 2 , 3 hours after meal. The fasting blood sugar is good but all the tests after meal is always high. So, I decided to get a glucometer yesterday to monitor my blood sugar at home. I will make a graph to show to my endocrinologist. I read that Vitamins E and C affect the result of the AIC test. I wonder how many days should I stop taking them before the AIc test. I will take the test this coming Thursday.

Stress? Oh, I have plenty of that lately...I am trying consciouslyh ard to remove the stress but I just could not shake it up. I did not realize that infection can elevate the sugar? Could this be one factor why my s ugar is elevated?

I could not open the first link. The Norton Security in my computer blocked it with the message: "Malicious Website Blocked".

I do my exercise at a minimum 5 days moderately. I always eat my breakfast before doing the exercise. I cannot do intense exercise because of my feet and legs.

My numbers after meals have not reached 150, my main concern though is the number goes down very slowly and by the next meal comes, the number is just almost down to normal (but not quite e.g. 111 or 112). :confused:

When are you measuring? One hour and then two hours after eating? One hour is important.

As we age, the insulin response curve does change.

Your A1C is more predictive therefore than blood glucose measurements. New research is showing that slowly elevating A1C is common for the elderly. And that it is not exactly smart to
aggressively treat at typeII diabetes anymore.

I put those papers up recently on a thread of Glenn's.
http://neurotalk.psychcentral.com/post947907-8.html

before each meal (big or small) and 1 and 2 hours after each meal. Sometimes, even 3 hours, when I can.

Mrs.D, this is quite a relief. But, I will still continue to monitor my sugar at home just to know how I fare with my eating. As you know, I need to gain weight. As you may know, MAC competes with the "calorie consumption". But, with this sugar elevation, its hard to balance maintaining hte a good level of sugar and adding more calories to my diet:confused:

I will have my AIc test tomorrow, lets see the result of the test.

Again, thank you so much for your valuable information. I cannot thank you enough.

That is great. So many people just measure after two hours. The spike needs to be looked at earlier. :)