Detecting hidden glucose issues
 

I finally found a link I'd been looking for, and wanted to post it here for anyone who is going to go down the path of checking for blood sugar issues.

For those who don't know me, I pass all normal diabetic screening tests with flying colors, but below is what further investigation on my part showed.

After a very high carb meal of pasta and bread, this is what my blood sugar did:

Pre-meal: 85
30 minutes post-meal: 166
1 hour post-meal: 162 (under 140 deemed normal)
2 hours post-meal: 166 (under 120 deemed normal)
3 hours post-meal: 148
4 hours post-meal: 128
6 hours post-meal: 82

It took me over 4 hours to return to what would be considered normal post meal blood sugar levels when I should have been there in two hours.

This link tells you how to test with a glucose meter and interpret the results:

http://www.phlaunt.com/diabetes/14046889.php


This link shows what normal blood sugar levels should be. I've read as high as 188.

http://www.phlaunt.com/diabetes/16422495.php


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Hi there,

My small fiber neuropathy is not related to diabetes, so I have been advised by my professor in London...but...I had diabetes in both pregnancies so have a bit of knowledge re this

I am quite small and thin and do not have any weight issues but when I had my first son it was picked up on a scan that I had too much fluid, I was then given a glucose tolerance test which showed slightly raised glucose, I think it was 8.1 after 2 hours. Should be under 7.8. I ended up having a C-section as it was quite risky with all the fluid.

With my second son they monitored me very closely , I had to test before and after meals, my bloods were running high after meals, but strangely I had an normal glucose tolerance test. The consultants said even though I had a normal test it doesn't mean I don't have it! so this proves that the test isn't that accurate to pick up pre-diabetes, the only way to know for sure is if you test after meals with a kit, to see how your body reacts to different foods. Just by having slightly raised blood sugars caused big problems for me in my first pregnancy, so I am guessing that if left unmanaged could cause other problems too i.e. small fiber neuropathy.!

Can of worms
 

I have been trying to get better at all things diabetic and I started this coaching program where nurses call and make appointments for phone schooling. My last conversation included instructions to test 2 hrs after meals and anything 180 or lower was cool. In my old process I tested fasting in the morning and 80-120 was good. I sure hated giving up those tortillas at McDonalds, but even more things are going to have to change. I'm not trying to open up a can of worms, I will peruse the link and check it out. Good Luck, Ken in Texas. P.S. Diabetes-horseshoes-handgrenades, as long as we are close.

That 180 number is consistent with what I've seen for diagnosed diabetics. I assume you are one? I think it's the ADA guideline. Other organizations like the American Association for Clinical Endocrinologists say the 2 hour number should be below 140 for good diabetes management.

The numbers in those links I posted are for determining if you have a glucose problem at all.

I'm sure there's a good deal of genetics involved with the susceptibility to neuropathy from all the various insults. Given no other theories, I'm going to consider myself to be a poor schmuck with bad sodium channel genes who has been done in by even mildly elevated blood sugar. If that's the case, I feel it's in my best interest to be an "overachiever" with regard to glucose management.

I think that's exactly what I've learned.

If any good has come of this neuropathy crap, it's that I've hopefully warded off an eventual pre-diabetes or diabetes diagnosis. But I'm also still kicking myself for not getting a better understanding of what developing reactive hypoglycemia meant.

I always thought glucose intolerance was pre-diabetes, but it wasnt, it was "pre-pre-diabetes", it precedes diabetes or pre-diabetes by many years. im starting to think GI is related to my pn, because it fits in the symptom(type and presensation) alot.

Harvard's Joslin Diabetes Center says 20 million people in the U.S. have Impaired Glucose Tolerance, and 1% - 10% of them will be diagnosed with diabetes every year. I'm sure a good hunk of them don't know they have it, as was the case with me.

http://www.joslin.org/info/diagnosin...rance_IGT.html

I posted a link to this report before on another thread, but I think it's worth posting again because of what it says about neuropathy. The case studies referenced ring very familiar and are worth a read, but I'll copy and paste the most relevant and summarizing areas of the report.

Peripheral Neuropathy and “Borderline” Diabetes

http://www.jabfm.org/content/17/2/127.full

"There is increasing evidence that patients with milder degrees of abnormal glucose metabolism, including impaired glucose tolerance (IGT) and impaired fasting glucose (formerly referred to as “borderline” diabetes), are also at risk for developing symptomatic polyneuropathy . We have personally observed patients for several years with “idiopathic” painful sensory neuropathy who subsequently develop overt diabetes; in retrospect, it seems likely that their symptoms were related to longstanding impaired glucose metabolism."

"DISCUSSION:

The cause of polyneuropathy remains unknown in more than 20% of cases despite extensive laboratory testing. The incidence of idiopathic cases is believed to be even higher among patients presenting with painful sensory neuropathy. However, some patients with “idiopathic” painful sensory neuropathy have ultimately developed overt diabetes mellitus after many years of follow-up, suggesting that occult impairment of glucose metabolism may have been the cause of their symptoms all along. There have been a number of recent series suggesting than more than 50% of the patients referred to neuromuscular clinics with a diagnosis of “idiopathic” painful sensory neuropathy have abnormal glucose metabolism when they are evaluated using the 2-hour glucose tolerance test (Table 3). Of these, more than 50% have impaired glucose tolerance, so the fasting glucose and glycohemoglobin are frequently normal despite an abnormal glucose tolerance test. These incidences of occult diabetes and impaired glucose tolerance are significantly higher than those reported for the general population, suggesting a causal relationship.

"CONCLUSION

Based on the data available in the current medical literature, we suggest that patients presenting with unexplained painful sensory neuropathy should be evaluated for impaired glucose metabolism with a 2-hour OGTT; if the results of the test are abnormal, they should be referred for lifestyle interventions and/or initiation of oral hypoglycemic agents in addition to management of neuropathy symptoms. Improved glycemic control can prevent the
development of overt diabetes mellitus and may have some impact on progression of neuropathy in these cases. The association between “idiopathic” painful sensory neuropathy and impaired glucose metabolism argues very strongly for prospective studies in larger populations looking at the cost effectiveness of this approach."


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I think i might have read that article, it said people with GI, might be the cause of idiopathic PN . Since diabetes, is the major cause of PN, it wouldnt hurt if there was more on pre-diabetes and glucose intolerance as well.

My doc just told me today that my last fasting glucose test was low (this was done over two months ago). Does low glucose cause sfn? I was eating very healthy at The time, very low carbs ( only what I got from a small handful of berries in the morning, and whatever was in my veggies at lunch and dinner). No other sugar, no gluten, only organic foods nothing that came out of a bag, box or can except a bit of tuna and some beans. Would this have impacted my reading? Does this mean I need carbs?

He ordered another glucose fasting test but I have been eating poorly for the last two weeks. Carbs and sugar too.

I am not sure what this means, please help

What was the value? "Low" could be mean a lot of things, like "normal."

As far as I know, there is no association between lower blood sugar readings and neuropathy.

Hi Janieg
I just noticed you take 100mg R lipoic acid twice daily. Is that considered a safe dose? Is it too high? I am currently taking 100 mg daily and thought of upping it but literature I read is contrary. Thank you:)

Hi Aussie,

When I first started looking into it, I read somewhere that you can take 600 mg of ALA twice daily to help with neuropathy as long as you have no side effects, including your blood sugar going too low. I can't lay hands on the exact article I read now, but I do remember reading that. I started with 100 mg of R-LA, and when I felt no side effects, I bumped it up. I do believe it has helped me, but am soon going back down to 100 mg to see if I feel any difference. It is rather expensive.

I should also add that I tested low-normal for ALA in a NutrEval test, so that also factored into my decision.

I just did a little Googling and found this write-up on it. This wasn't what I read initially, but what I read was probably a summary of it as I remember it had references to a German study.

http://www.diabetesaction.org/site/P...lementary_5_12

"A small Romanian study of 26 patients found symptomatic improvement with oral ALA (600mg daily) after three months. Ziegler replicated these findings in the 2006 SYDNEY-2 trial, finding that oral doses of 600, 1200, or 1800mg of ALA for five weeks led to significant improvement in neuropathy symptoms, with the best safety profile at 600mg. Notably, side effects were observed and included nausea, vomiting, and vertigo, which increased in a dose-dependent manner between 1200 and 1800mg per day."

Cheers!

Janie

Janieg and others

Just came across this article from the Linus Pauling Institute about using Lipoic Acid to treat PN in diabetes. Thought it relevant to the topic of this thread.

http://lpi.oregonstate.edu/mic/dieta...ease-treatment

What's funny is I had a 2 hour blood glucose test which was 90 (pre) - 120 (1hour post) - 90 (2 hours post), all great numbers according to my doc. My A1C is 5.3, again great. Fasting Glucose of 83 and 90 most recently.

But then, i can eat something like what you mentioned and really rise up to areas of 168 ish and hour or two after and see a very slow fall back to just barely below 100. It can sometimes have me hanging up at 100-105 into the next morning. Very odd.

The glucose drink used in the GTT is pure sugar and we often react fine in that test. But it is only 75g of sugar. There are meals that actually can go way above what you get on a GTT. Also things like Dairy will have your blood sugar slowly rise and slowly fall. So you can be sitting at a high reading for a while.

I myself put a lot more stock into results obtained from a needle that takes a lot more blood though. The glucose meters are ok but they are really only good for tracking how levels change and dramatic differences over time. Their accuracy can be off by 10 - 20 depending upon the meter. So, you can make yourself a little crazy over a reading of 105 when you may really be 90. Or a 180 that may be closer to 160.

Hi Patrick,

You are correct that meter readings can be off and to stress over something 105 that may really be a 90 is futile.

I am diabetic and rely heavily upon my meter for insulin dosage. I always do my own reading right before having a lab draw. My most recent one was 1 point different than my meter. It is usually never more than 2 points different. That is how I check the calibration of my meter to know that I am getting accurate results.

As a diabetic, I also know when a reading from my meter should be of suspect. If a wake up and have a fasting blood sugar of 166, I know I need to re-check. Did I test too soon and the alcohol was not dry? Did I have soap residue on my finger?

Whenever I get a reading that is not what I expect, I always test again within a few minutes to verify. The day I got the fasting 166, subsequent test showed 168. It WAS a correct reading. My fasting levels returned to "MY" normal the next day. It was just an odd day in the life of this diabetic. I will get an abnormally HIGH FASTING level about once a month. Don't know why but I do verify that it is a valid number and not a meter mistake or some other external source that caused an erroneous reading.

To your point, I used my glucose meter in conjunction with my GTT. I went out into the car and did it right after each blood draw and the readings were absolutely dead on when i got my lab results back. I use a TruTrack.

My 1 hour level is 181. Two hours is 71.

My new primary care physician wanted to to know whether I had ever been declared pre-diabetic by a doctor, or whether I had just declared myself one.

Yeah, just me.



Numbers Matter: 1-Hour Post Prandial Glucose Possible Predictor of Prediabetes Risk

"Previous studies have suggested that the 1-hour glucose level above 155 mg/dL is a better predictor of progression to diabetes than the 2-hour level. The researchers conclude that present findings, in conjunction with the other observations, suggest that individuals at high risk for developing diabetes could be identified earlier by measuring the 1-hour postload glucose level."


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Hi janieg

If your new PCP had bothered to ask the question properly instead of just insinuating that self-diagnosis isn't useful then your answer may have been: 'yeah just me - after researching, observing and testing'. :rolleyes: I hope as he/she gets to know you better they might learn to accept that some patients know how to manage their own health.

Thanks for the link to the article - I wonder what implication it may have for medical systems that currently rely only on the HBA1c test as an indicator for diabetes.

I had a new patient appointment with my new PCP (referred to by a friend), and she barely batted an eye at my SFN. Saw all the tests the neurologist had run, and didn't ask me a single question.

I'm supposed to have an annual physical with her in August, and am thinking about looking elsewhere. But where? Sigh.

Hi Janie. Did you use a 75-gram glucose drink for your 1 hour test or did you just eat a normal breakfast? I had a 2 hour post fast test after eating breakfast and I'm wondering about the reliability of the test as my breakfast didn't contain much sugar (including food that converts to sugar.) I'm sorry if this is a dumb question. :o. And for your information I think just you are terrific.

I did the two-hour Oral Glucose Tolerance Test with the 75g glucose drink. It was downright disgusting. :D

Fasting - 80
1/2 hour - 144
1 hour - 181
2 hours - 71

I became hypoglycemic on the drive home, but thankfully I was close to home when I realized what was happening. I carry glucose tabs on me at all times now...although I haven't needed to take any yet.

Thanks, Janieg for this important topic!
 

Hi janieg,

I have been following your thread.
Thanks so much for starting this thread. This is a very important topic.

I have read the oral GTT is truly the best way to check on how we handle glucose. The A1c is okay, yet really doesn't tell the whole story for anyone.

I have an aunt whose story is similar to yours. She had perfect A1c tests. She had been diagnosed as type 2 diabetes. She had good control with her diet and her meter readings were just fine. However, she was experiencing diabetic retinopathy and neuropathy. An oral GTT helped to figure out just what was going on for her, thankfully.

I stay on a very low carb diet and feel much better when I do so.

Thanks so much for sharing and for raising awareness on this very important topic! :hug:

With Love and Gratitude,
DejaVu

I check my levels on occassion and everything seems to be OK. but then i dont eat things that send me sky high. Oddly enough potatoes affect me way worse than simple sugar does. not sure why. i could eat a plate of french fries and go up to 150 an hour later. I could eat a plate of 2 eggo waffles and maybe hit 115-120 an hour later. Maybe because the potatoes are fried? No idea. A plate of french fries actually does have double the carbs than Eggo waffles does. Just something with my metabolism i guess. My 2 hour OGTT was 90-120(1)-90(2). I don't think that test is good for much really. Who eats that way? I don't like that i am always around the "90" baseline though. I ask all the doctors and they say you're dealing in nuances there, everyone has a different baseline based upon their body type and genetic makeup. There are some days where my fasting is in the 80's though. A lot of variables. When you have idiopathic SFN you are always looking for things. I had a top neurologist said SFN, when Idiopathic, is usually pre-diabetes or heading in that direction and we just need to watch and see. They are seeing it more and more. So, of course its something i will keep an eye on.

Supplements like R-Lipoic Acid, B1 and Grape Seed Extract have had a noticeable effect on blood sugar control for me The three in combination have a great effect. On their own they are not as powerful but combined they are very effective. To be this obsessive is a blessing and a curse and that's what "idiopathic" will do to you. My wife says why do you check if all the doctors say you are not even pre-diabetic? I say, these are the same doctors who cant find out what caused my SFN.

Blood sugar levels are constantly changing throughout the day and night. Just a fact.

And you are correct that different people have different baselines all within normal range when there is NO disease process. It is a matter of body metabolism.

Peripheral neuropathy is NOT limited to diabetics but it is always one of the first things checked when PN symptoms appear to rule that out.

There are some NEW lab tests out just recently regarding blood sugar levels. I was just reading about one a few days ago.

A CGM is a good method for seeing what your blood sugar does every few minutes over several days, usually 4 to 7 days. Many doctors are reluctant to have a patient wear the device for a short duration due to cost and is usually reserved for use in a diabetic for which medication is not working and a better record is needed than one with a regular meter and lab testing. (CGM is a continuous glucose monitor)

These devices are primarily used by type 1 diabetics on an insulin pump. They wear them all the time.

I have seen CGM's used on a one time temporary basis with type 2 diabetics to aid in determining the proper medication regimen.

Fast and slow carbs act differently upon some people as you mentioned.

Also, just one bite of rice will skyrocket blood sugar levels in some yet the same person can handle other starches better, like potato or pasta.

Blood sugar is NOT a one size fits all for sure. Some baselines are in the 70's, some the 80's and others the 90's without any disease process.

Fasting blood sugar levels can change also just with movement of the clock. I can do a fasting blood sugar level at 6 AM, continue fasting completely, no food or even water, and do another fasting blood sugar level at 9 AM and it may be 30 points higher. (But, I AM a diabetic.)

Blood sugar levels are very complex and what is normal for one person may not be normal for another. Levels change all day and night for everyone, not just diabetics. When the body does not make the proper adjustments to these changes is when one is declared diabetic.

Your numbers are fantastic, Patrick. And that one hour number of 120 supports what I've read that in a "normal" person, the postprandial number would never exceed 120 - 140 no matter what is eaten. That's why my 181 number bothers me. And of course the crash an hour later is a definite indication of a problem.

Here's something I discovered about my FBG number. Before I went low carb, my fasting number first thing in the morning was consistently in the low 80s. After I went low carb, it was consistently in the high 80s/low 90s. I was completely perplexed until I read something somewhere (great source) that once your body adjusts to a low carb diet, it is no longer is "panic-stricken" about keeping your blood glucose as low as possible in preparation for a carb onslaught. It will allow your FBG to drift higher because it knows it won't have to work as hard when mealtime comes. Kind of makes sense.

I personally wouldn't worry at all about your 90 number.

Great discussion!
 

Thanks to everyone posting in this thread.
Lots of insights and helpful information.
It's truly so very important for each of us to know our own baseline numbers and to investigate as thoroughly as possible.

Thanks so much for sharing here.:)

Warmly,
DejaVu

Glucose testing
 

Sorry if this sounds like a dumb question, but when you have eaten your bagel or whatever high carb item you choose, how long after that can you eat anything?

Do you have to wait the full three hours before you can eat again?

Can you eat anything in addition to the bagel? Fruit? Can you have a coffee?

Thanks, Linda



Now eat something containing at 60 - 70 grams of fast acting carbohydrate. A bagel makes a good test food.
One hour after you started eating, test your blood sugar with the meter. Write down the result. If you lose track of the time measure as soon as possible. The numbers will still be useful.
Two hours after you started eating test your blood sugar again. Write down the result.
Three hours after you started eating, test your blood sugar. Write down the result. You are now done and can eat whatever you want.or

from what you have written there dont eat anyting else until after you have taken your final reading at 3 hours

Make sure you get 75g of glucose/sugar in whatever you eat/drink. A study done several years ago says jelly beans are good alternative to the drink normally consumed. Water is ok to drink during the test based on what I remember.

I was stuck four times: fasting, 1/2 mark, 1 hour mark, 2 hour mark

[QUOTE=janieg;1215475]Make sure you get 75g of glucose/sugar in whatever you eat/drink. A study done several years ago says jelly beans are good alternative to the drink normally consumed. Water is ok to drink during the test based on what I remember.


Thank you both, I just wanted to make sure I was understanding this properly!

Linda

I am in the same boat. Drinking 75g of Grape juice, I hit 135 within 1 hour then went down to 90 after 2 hours.

Did the same test with 3 slices of Pizza and a coke, hit 170 in 30 minutes! then 148 in hour 1 and 143 in hour 2, 108 in hour 3.

I definitely diagnosing myself as Predibetic. Don't care what my doctor says. (he says I'm fine cuz my FG is 97)

I think most doctors follow a script based on ADA recommendations which don't kick in until your meet their guidelines for pre-diabetes. Wouldn't it be better to warn people before then to get the process stopped as quickly as possible? If someone's FBG or A1C is creeping up year after year, they need to understand what that means.

Doctors are not intervening and issuing warnings to patients as fast as they should, IMO. The statistics are sobering.


Statistics About Diabetes: American Diabetes Association(R)

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