Anyone want to take a stab at interpreting GTT results?

1

I've been tracking my blood sugar for the past 4-5 months. I finally realized that the headaches, shakiness, mind-fog etc. might be low blood sugar related, and sure enough once I started testing, I could see a pattern. My PCP ordered a GTT, and below are the results.

fasting - 95
1 hour - 172
2 hour - 57
3 hour - 74

I can't remember what my a1c was, but it was under 6 (5.6?)

Since then, I've been to a nutritionist, and have made changes to my diet. Smaller meals throughout the day. More whole grains, fiber, vegetables, proteins, and less bad carbs (white rice, bread, pasta) along with reducing sugar anywhere I can. I think it has helped, since I can definitely see that my numbers are more even, and the swings are less drastic.

But. There are still times when I am low (55-60) regardless of the small meals/snacks. I'm also finding weird highs. 145, 167 even when I've forgotten to eat. The same salad on two different days can put me at 140, or at 89.

At the same time as the GTT, I also tested positive for one of the markers for lupus, although I don't seem to have any symptoms. I was gestational diabetic during my pregnancy (13 years ago), and had to go on insulin almost immediately after dx. My father was type 2. He was also obese, smoked for a number of years, and had a long history of cardiac problems and poor diet. Even after he was diagnosed, he never seemed to get control his blood sugar.

I could stand to lose 10lbs, but am fairly active, and in general didn't have a bad diet to begin with. No, I wasn't eating small "appropriate" meals, but I never really ate fast food, drank soda, or gorged myself on massive amounts of chips/cookies/candy.

Should I be doing anything different other than my dietary changes and keeping active? I realize my #'s are nowhere near alarming, but I'd like to get better control over the roller coaster.

Thanks for any input.

2

Have you modified the I:C ratios too? With numbers in the 60 range it can be expected that one unit does cover more carbs than you are expecting.

The analog insulins are very fast. In my experience the speed of absorbtion for carbs does change. Usually it is marginally getting slower over the years. This could lead to a situation where the insulin always overtakes the digested carbs. You could try different analog insulins to find the slowest for you - very likely Humalog. After that you could try the good old regular insulin - like Acctrapid. This insulin might better fit to your current eating style of small portions and less carbs.

Have you verified that your current basal dosage is keeping you stable? Maybe you could reduce your basal by one or two units too?

3

I'm assuming you are no longer on insulin. This is called reactive hypoglycemia. What happens is the body overreacts to the glucose load caused by a meal containing fast acting carbs. Too much insulin is produced and blood sugar falls after the carb load is dealt with. Your medical team is giving you the standard treatment. The weird highs might be your liver dumping glucose and not stopping as it normally would, this would be consistent with pre diabetes although personally I think pre diabetes is really early stage diabetes and should be treated aggressively to prevent further deterioration caused by the high blood sugars. Metformin might help this. I think frequent testing is a good idea, you may be able to identify foods that are causing your problem. Perhaps a lower carb diet ala Atkins or Bernstein would help. Most nutritionists will tell you eating whole grains will cause less of a spike but it can still be nasty. Limiting or eliminating starch will probably help. To learn more about eating to your meter check out the bloodsugar101 website.

4

Thanks for both of your replies. I should have been clearer; once I gave birth, my blood sugars returned to normal, and I was told my diabetes was gone.
No insulin, food logging, or anything else. Here I am 13 years later. Stricter carb counting makes sense, and I will need to watch
it closer.

5

Not all carbs are created equal some are very fast acting some slow. The fast acting ones are probably causing your problem. Keep records of what you eat and the results so you can make intelligent choices about what you eat. Good luck.

6

Thank you. I didn’t know that there were phases to insulin response although that explains why it dips sharply afterwards. I’ve been eyeballing carbs, and trying to primarily eat high protein, high fiber w no sugar. I will need to look at portion size and tighten it even further.

Fasting this morning was 93, and after lunch (large leafy salad w chicken, egg, and raw veggies) it was at 80. That also includes the instant hot chocolate I drank to warm up (it was 50 degrees here in the northeast!).

Compared to what others are dealing with, my problems aren’t so very big… Thanks again for educating me. :slight_smile:

7

Even lower carb than now to avoid stressing the pancreas (since your phase one response is not correct) to prevent full diabetes in the future ? Wow instant hot chocolat that would send my BG to the moon maybe you are fine for the moment.

8

I had some dizzy spells lately, none of them related to lows. I feel light-headed, dizzy, and once I even passed out completely. My doctor had my cortisol levels checked. I haven't got my results back yet, but it might be something to consider.

9

I agree Anthony, I fully expected a high (150-ish). I am not sure what to think… Yesterday I went from lunch to dinner with nothing to eat (poor planning on my part). Before dinner, I tested and I was at 145.

10

Ugh, passing out is not fun! I hope you get an explanation when you get your results back. (post if you can)

11

Great you're being vigilant about testing. Agree with the other suggestions that yours sounds like reactive hypoglycemia. I was hypoglycemic for years before being diagnosed T1 & no doctor told me this was something to be concerned with. Meanwhile, my beta cells were dying.

13

Gerri, you were hypo before you were diagnosed as T1? Are you saying that had you been tested earlier, they would have determined then that you were T1?

Bear with me, because my diabetes knowledge isn't very deep. I know that you can be diagnosed with T1 at any point in your life, but I also thought it meant that your pancreas was no longer able to produce insulin at all. How is that determined, and would your treatment plan have been different if you knew earlier?

14

Hi Angela,

I was hypogylcemic for a very long time before finally crashing with DKA & ending up in ICU. I knew I was hypo because I'd get ravenous, feel strange, cranky & eating immediately made me feel better. My fasting glucose from annual blood tests was low. If doctors over the years had taken any interest in my hypo symptoms & explained hypoglycemia could be a precursor to diabetes & to monitor BG, I could have preserved some beta cell function. I ate a very high carb vegetarian grain-based diet, which was stressing my pancreas. But, I didn't know anything about diabetes & there's no history of diabetes in my family.

So, the treatment should have been monitoring, testing & changing my diet to have prevented almost dying from DKA when my pancreas finally gave out. I'm not saying this could have stopped T1, but I'd be healthier now. I was diagnosed at 53 & may have been able to avoid T1 for longer.

People with T1 can produce some insulin. The tests are a GAD antibody panel to determine autoimmune attack & C-peptide. C-peptide is produced in direct relationship to insulin. High C-peptide is indicative of T2. Low C-peptide indicates T1. Had I been tested periodically (or even had a OGTT), the path to T1 would have been clear as GAD went up & C-peptide went down. I would have started on insulin earlier.

15

Thank you for the explanation Gerri. It helps to know that diet can have such an influence in the development & progression of diabetes. I guess I should say that it helps to know, but then the key is actually making those changes; that will be my challenge.

I also recently tested positive for one of the markers for lupus, which is also an autoimmune disease. I don't know if they are related. It is something that I will bring up with my PCP when I go back next month.
Thanks again.

16

Thanks for the diet pointers Emmy - I love raspberries/strawberries and any kind of berries, so I've got that working in my favor.

17

I've not heard of a link between diabetes & lupus. However, it's not uncommon for people to have more than one autoimmune disease. Perhaps one marker is insignificant.

There are T2s who control just through diet & exercise. Judith is a shining example.

I thought I was eating well following a vegetarian diet. I never had a weight problem & never ate junk food, processed food, sugar, white flour, soda, etc. Ate whole grains we're sadly told are healthy--ha! My diet, even without the usual suspects, was extremely high carb.