2-hour post-meal over 220, but non-diabetic?

Type 1 and LADA
1

Hello everyone, I'm new around here and haven't posted anything because I'm not really sure which forum to post this in. Thanks to those who welcomed me, by the way.
First of all, I'm a really thin 27yo male, 5'6" and 100lbs. I usually average around 107lbs, with my highest at 118lbs back in 2011, but somehow lost weight recently. I don't drink and live a sedentary lifestyle. No family history of diabetes but then again, some them haven't had a blood test done in over a decade.

Anyhow, in the past few months I've been experiencing fatigue, usually after meals, constant thirst and frequent urination (even at night). I wound up at the ER for other reasons, and had a random blood test done. It was 163 mg/dL, which I thought was a little high for a non-diabetic because it was higher than 140. I went to the doctor's office for a fasting blood test and it was 91 mg/dL. She said I was normal, but I decided to cut back on soda and candy anyway.

A few months passed and I was still experiencing after-meal fatigue, constant thirst, frequent urination, but also night sweats. Eventually I got my hands on a glucose meter and some test strips (OneTouch Ultra-mini) and decided to test my blood sugars after my usual meals just to see how high it actually spiked.

Pre-prandial: 79 mg/dL.
I then had a regular bowl of white rice with homemade beef/shrimp/scallop/vegetables and some strawberries/blackberries for dessert. (see attached photo)
1 hour: 163mg/dL
2 hours: 219mg/dL (I thought this was a fluke at first so I re-tested 3 minutes later to make sure), 224mg/dL.
2.5 hours: 191mg/dL
3 hours: 175mg/dL
4 hours: 95mg/dL
Impaired glucose tolerance or diabetes? I wasn't sure so I tested again the following day.

Pre-prandial: 75 mg/dL.
I then had a regular bowl of white rice with chicken curry and some strawberries for dessert. (see attached photo)
1 hour: 178mg/dL
2 hours: 227mg/dL
3 hours: 173mg/dL
3.5 hours: 153mg/dL
4 hours: 116mg/dL

I visited another doctor for a 1 and 2 hour OGTT test and an HbA1c test. HbA1c was: 5.5%
OGTT Results with 75g Limeondex:
Fasting: 73mg/dL
1 hour: 183mg/dL
2 hour: 177md/dL (High)
The 2 hour specimen was listed as Out of Range on the lab results and fell into the impaired glucose tolerance category.
About four hours after ingesting the drink, I felt shaky, weak, dizzy, sweaty and my heart began racing. Grabbed my meter to test myself and it said 37mg/dL. I quickly chugged some fruit juice and the symptoms eventually went away. I felt tired after that and took a nap only to wake up an hour later soaking in sweat.

Anyhow, I've found out the white jasmine rice I've been eating my entire life causes the highest BG spikes. I don't want to know how high it actually spiked during the times I had seconds and drank soda.

My doctor tells me I'm completely normal and didn't seem concerned with any of my home-testing results. Do I trust my doctor and continue eating like I always have? How should these results be interpreted? It would be great to have some second opinions.

Sorry for the long post, and Thank You for your time.

-ToeKnee
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Blood test results as of March 10, 2014
HbA1c: 5.5%
Total Cholesterol: 140 mg/dL
Triglycerides: 47 mg/dL
HDL Cholesterol: 77 mg/dL (H)
LDL Cholesterol: 54 mg/dL (L)

810-430meal.jpg (75.4 KB) 811-501meal.jpg (77.5 KB)
2

Hi TK,

You definitely have impaired glucose tolerance from your OGTT. I'd think the next tests to do would be your antibody tests. In the meantime, your meals are really carb heavy. Try cutting back on the white rice and fruit and see what that does to your post-meals.

Either way, get your diabetes related autoantibody tests done. There is a whole panel of them but I would think you are a prime candidate.

3

Even though home blood glucose meters are not as accurate as lab equipment, they still indicate that your BG goes high after eating. Your OGTT showed a significant rise at both the one hour, 183, and the two hour, 177. The combination of these two events makes me suspicious that your BG metabolism is impaired.

I would seek a second opinion, preferably from an endocrinologist. I don't see your numbers as normal. If it were me, I would pursue more aggressive action at this point. The doctor seem content to let your situation progress until it dramatically exceeds diabetes diagnosis thresholds. Excessive thirst and frequent urination are classic diabetes symptoms. If you have diabetes or are trending in that direction then early intervention may extend residual pancreatic function for a longer time. This potential benefit is considerable and shouldn't be discounted.

4

Your doctor is absolutely incorrect to suggest that you are "completely normal." Your A1c is normal (although on the higher side of normal given your apparent fastings in the 70's), but your post-prandials and OGTT are anything but "completely normal."

To me, this seems like a relatively classic presentation of Latent Autoimmune Diabetes of Adulthood (LADA) (speaking from my own LADA experience). As already recommended, you should see an endocrinologist and should be tested for auto-antibodies.

As for your eating habits, until you see an endo, if only to reduce the apparent strain on your pancreas, I'd cut down the carbs to at least the "regular" diabetes diet of 45-60g per meal.

5

I'm gonna agree with this poster , get an endocrinologist asap. That's the best way to start here.

You're very likely a diabetic and I'd lean towards type 1. I don't use the LADA label because it's type 1. In Adults, type 1 onsets somewhat slower for most people. I mean, you could STILL be a type 2 but I'd say no not when you're pretty healthy sounding other than this and the fact that you're underweight and you're only 27, also having no family history of diabetes is more indicative of type 1. Your symptoms (Thirst, frequent urination, fatigue, and unexplained/unintended weight loss) are classic diabetes symptoms. You need to get to an endocrinologist and get tested further and ask for autoantibody tests (GAD 65 for example and there's others, I'm pretty sure if Melitta shows up she'll explain this part better) and make sure the endocrinologist knows your symptoms and explain your weight loss. Don't let them just throw type 2 at you at 27 years old unless you are legitimately a type 2.

You're not alone here though , and IF I am right on you being diabetic and being a type 1 you fit right in as there's a lot of type 1's diagnosed as adults here (including myself) .

6

Hi TK: I agree with what others have posted. If I were in your shoes, I would get to another doctor who will take your symptoms (classic for new-onset Type 1 diabetes) and your results seriously and not blow you off. The doctor can order autoantibody tests (GAD, ICA, IA-2, IAA, ZnT8) and a c-peptide test. Don't get just GAD, because a small but significant percentage of people with new-onset Type 1 diabetes will be GAD-negative but positive for one of the other autoantibodies. I wrote a blog on autoantibody testing that you may find useful.

I am glad that you have found TuDiabetes and that you are being proactive about your health. It's your life, you have to be your own best advocate.

7

Comstant thirst, frequent urination, unexplained weight loss and abnormal BG readings. You are NOT normaal. There is most defiitely a problem. That point is NOT debatable, at all.. Unfortunately too many doctors take the same dangerous view of these symptoms. I've seen it happen to friends. If it were me I would NEVER see that doctor again for ANY reason. Heed the advice you have been given. Find an endo or a really good pcp and get the help you so obviously need. Run, don't walk. You are putting your long term health at great risk. I know this from personal experience. My story has the same beginning.

8

Your A1c, cholesterol levels, and triglyceride levels are ones most people with diabetes would be thrilled to have. At the same time, the highs you're experiencing after eating are certainly worrying. I'm not going to say that I know for certain how many carbohydrates you're eating and if you should change your eating habits -- I am not a doctor or CDE -- but I will say that if you're concerned, you should talk to your doctor and express your concerns to him/her. Based on what you wrote, if I were you, my concerns would be:

1) High blood sugars after eating
2) Weight loss (5'6" and 100 lbs is way too thin, as I know you know)
3) Symptoms that suggest diabetes (weight loss, frequent urination, constant thirst)
4) Lows that happen after consuming carbohydrates (that 37 mg/dl is definitely not good)

I do think I can explain why your bgs stay so high after you ate those meals you reported. When you ate those carbohydrates, you also had some proteins and fats with them, too -- IOW, a normal, human meal. Proteins and fats slow the absorption of carbohydrates throughout the digestion process. Look at the difference in when you hit your highest bg reading when you ate and when you had the glucose tolerance test. It took until 2 hours after you ate a meal before you hit your high, whereas it took only 1 hour to hit your high after the glucose tolerance test. Your body had nothing in it during the OGTT to slow the glucose's absorption. After the meal, because your body had to deal with the protein and fats as well as the carbs, your bgs stayed higher for a much longer period of time, thus leading to those bgs of 173 after 3 hours, whereas your bgs were down to 177 after only 2 hours with the OGTT.

While some have said you should cut out carbohydrates, I'm not so sure you actually have to do that. One thing you can do is to increase the amount of fiber you're eating. So, instead of jasmine rice (and I know how hard it is to give up that particular rice!), use brown rice with more fiber. Try whole wheat pasta. Substitute whole wheat bread with 5g fiber per slice for the plain white bread. Add beans (very good for you!) and apples with the skin on. Fiber will also slow down the absorption of carbs you eat and will help with digestion. Make sure you eat foods from both soluble and insoluble fiber sources, as each has its own benefit.

Should you go see an endo? Well, that is up to you. It certainly does sound as if you could use a second opinion from someone else. Doctors can and do make mistakes and it certainly can't hurt to get another opinion.

You know, while the ACA is supposed to make it illegal for insurance companies to deny insurance to those with pre-existing conditions, for so long doctors have been forced to play games with diagnosing people with chronic illnesses, so people wouldn't be told they cannot be covered that I'd bet many doctors are still operating under that principle. I wouldn't be surprised if the doctor you saw and interpreted those OGTT results is one of them. Does that mean he/she is a bad doctor? No, just one who may be operating from a set of ideas that no longer count. Whatever the reason, take a deep breath, forgive him, and move on to the next step, whatever it is you decide to do.

9

Sounds to me like you're on your way to type 1 coming out from your symptoms. I disagree with your doc completely. There is no way a reading of 225 is normal, whatever is causing it. Hypoglycemia is commonly experienced as a prescursor of diabetes. Listen to your symptoms and get to another doc, an endo preferably, who will listen to them also. You don't want to end up in an icu unit or in a coma etc. with damage. Get all the antibody testing/c peptide testing. You can see if eating lower carb & more activity helps you too. Good for you for getting your own meter and starting to self evaluate- if you're lucky you're in very early phases and there may things you can do to stop it from progressing more.

10

Thank you everyone for all of your informative answers. I had a feeling these numbers were abnormal. I will look into getting those auto-antibodies tests, but finding the right doctor will be tricky.

In the meantime, I've been doing a lot of testing with various meals and replacing anything white or refined. It took a while to get used to but switching from white to brown rice made a big difference in my blood sugar levels (1hr: 146 / 2hr: 121). I still can't eat fruits right after the same meal or I get about 20 points added to my BG (1hr: 167 / 2hr: 144). The brown rice also has to be prepared just right, too sticky and I get BGs in the 160s at the 2hr mark. Had the same chicken curry meal with brown rice: (2hr: 147). Even 1/4 my regular portion of white rice and I still spike up to 183. At least fried white rice gets me numbers similar to brown rice. Well, I gotta go now. Thank you for all the advice.

11

But are you eating less food in general to do this? Besides cutting out fruit (which while I'm not as big of a fan of fruit as you seem to be, you should include in your diet ...) like are you cutting your portions down? The good news is you're getting better numbers, at least those should keep you going until you get an endo. Just don't do what I did and starve yourself to maintain those numbers. Between my misdiagnosis and proper diagnosis I was eating less than 80 carbs (often less than 60 ) a day and would go long times without eating much of anything. This was bad and only made things worse for my blood sugar and overall health. With insulin I can eat pretty much whatever I want and maintain good numbers, so that's the big difference between being misdiagnosed and properly being diagnosed and having the right treatment.

Maybe if you can tell us where you live in the US, one of us can help you find an endo that will help you? Probably one that handles adults with slow onset type 1 well? I mean sure, it does depend on insurance, but hopefully if someone can help you find an endo they'll work with your insurance.