Confusing diagnosis results?!


#1

I am SO confused!
I had lab work and was diagnosed as type 2 diabetic. My AIc was 6.0% w fasting glucose 131 after a 12 hour fast. I then had a 2 hr OGTT w a fasting glucose 135 (9 hr fast) and a post glucose 225. However I laid down on an exam bed and slept while I waited. I then read online after that laying down and sleeping can skew the results so I had a repeat OGTT which showed a fasting of 115 (11 hr fast) with a 2 hr final repeat of 115…so zero change in my pre and post glucose results on this 2nd test. A fasting insulin level was also ordered and came back at 46 iUl/ml (!!!) which seems super elevated from the info I’ve read online.
Edit : regardless…wouldn’t a 225 result even laying down and sleeping be a slam dunk dx regardless of my wonky 2nd test results because any non diabetic person would never ever rise that high on a lab drawn 2 hr post OGGT?

I checked myself w my home glucometer during this 2nd OGTT and had 120 pre, 225 at 1 hr and 125 post as comparison. Hands washed very well before my own finger pokes.

In the last 2 weeks my fasting gluc has been around 115 with the max glucose ever reached being 178 and that’s with drinking 500 mls regular Pepsi and a giant plate of spaghetti / another try w a 12 inch pizza and 500 mls regular Pepsi and both post prandials were max 170. I’ve read to be diagnosed you only need ONE value above the threshold (126/6.5/200) which I’ve hit 2 of. I’m just confused how I can be so random w totally normal results and then have some clearly positive test results but then totally normal results after eating a massive like 100+ grams of carbs in one meal.

Wouldn’t my levels be spiking super high after massive carby meals/be higher fasting AM results/not be so up and down ?

Even my doctor was really confused with the totally different glucose results and the overall picture but he still prescribed my Metformin 500 mg XR to start and then going up to 1000 mg XR (will be picking it up soon)

Any thoughts ? Has anyone had a similar experience like I have ?


#2

Hi,

In fairly early diabetes blood sugars (and pancreas response) can be quite variable and unpredictable (ie. sometimes not much rise, other times very high).

Your testing with pizza and pepsi/ spaghetti are not controlled tests… and the fats may definitely slow absorption - you may have had a delayed high which you did not detect. Early on you may get high spikes after eating, but they do come down. If you did not test at the right time you may not actually catch the spikes.

Irrespective the high glucose levels (even if short term) and the high insulin levels (which are a precursor to the high blood sugars) are still a concern for health.

Your hba1c of 6.0 gives you an average blood sugar of about 135. Ideal would be hba1c of 5 or less (average blood sugar of about 100). The high fasting insulin also supports the type 2 diagnosis. And your fasting blood sugars are higher than optimal (Ideally < 95).

Seems you may be “lucky” to have caught this fairly early. The metformin should be helpful, and it may be helpful to restrict carbs and particularly added sugars.

Hope this response helps.


#3

It sounds like you’re in the early stages of diabetes whether type 1 or type 2 you won’t know without further testing, however high insulin production does point toward type 2. Your pancreas is still working just not optimally, so if possible you should think about making adjustments to your diet and exercise regimen.

I would try taking the metformin to see if you tolerate it. It won’t actually lower your BG but it will reduce the amount of glucose your liver puts out and lessen some of the absorption of the carbs you eat. I take it for dawn phenomenon and it helps but doesn’t entirely eliminate it.

Btw did your Dr ask you to start testing your BG prior to the OGTT or did you suspect something was off and decided to run some tests yourself?


#4

Asymptomatic. Dr asked me to buy a glucometer after my lab results/diagnosis. I’ve been testing AM, pre and post each meal daily. Should I ask for antibody testing ? I’m assuming I’m just Type 2 bc of my high fasting insulin level + it’s not like my A1C level or glucs are consistently high enough it seems to be a type 1 at all. I’m going to lose some weight and cut carbs to maybe 75-100 a day…thinking of giving that a shot then even trying Keto…I’ve been doing a lot of research on Keto. My sister eats Keto and loves it


#5

Hi thanks for the reply ! Yeah for example w the giant pizza/Pepsi test meal I tested at 120 pre eating, 148 @ 1 hr, 158 @ 1.5 hr , 169 @ 2 hr, 156 @ 3 hr and 147 @ 4 hr (I know this is excessive testing but I have a ton of strips and was totally curious to track it…) so nothing super nuts like over 200 but still impaired over ideal range at least at this one particular meal test! Makes sense that the fat slows it down but still after that many hours I’m still obviously over where a normal non diabetic PP range would be. Just so interesting how I’m all over the map in respect to values just in general w all my lab tests + over the last 2 weeks since


#6

I personally think everyone who is diagnosed with diabetes should get antibody testing just to be safe in case you are type 1 there won’t be any disasters down the road. Many type 1’s who are diagnosed in adulthood have a very similar progression as type 2, it’s usually referred to as LADA.

Whether you are type 1 or 2 won’t make any difference to your treatment at this point since your own body is still handling things. Something that will give you a more complete picture of what your bg’s are doing would be a cgm, the freestyle libre is an inexpensive option and works pretty well.

Welcome to the club no one wants to belong to but you’ll find plenty of support here and you can live a long and healthy life if you stay on top of it.


#7

Thanks for the tips
I’m in Canada (I’ve converted all my glucs measurements to American because I’m pretty sure this is a mostly US member forum). I’ll look into a libre. My health insurance through work only covers a CGM for Type 1s but the Libre looks cheap enough to pay for myself if I decide to go that route. I’m covered for test strips I pay 16$ for 100 test strips (+ 11$ dispensing fee I think if I buy more than 100 strips it’s only one dispensing fee so might just buy in bulk lol) so that’s a bit cheaper but I’ll research the Libre more!


#8

Actually there’re a lot of Canadians on this forum and I think most of us can figure out the conversion if we need to. Feel free to post in whatever format you’re comfortable in.


#9

Thanks for thinking of your readers! As @Firenza said, however, there are many Canadian members here. There are also members from Europe who use the mmol/L system. Whenever I post, I try to include both systems.

It’s good for the brain to try to think in both systems. It’s a simple 1:18 ratio. The low end of normal is 4.0 mmol/L (72 mg/dL), normal mid-range is 6.0 mmol/L (108 mg/dL), the upper threshold of normal is 8.0 mmol/L (144 mg/dL) and hyperglycemia is 10.0 mmol/L or 180 mg/dL.

I think adopting the Libre would be a good move for you. It can provide an education like nothing else. Learning about how your body responds to different foods is useful to know.


#10

Hi CdnGirl - I’m in Calgary and wanted to say hi, and welcome to the forum.

As far CGM costs, I’ve found that it’s often more beneficial to pay out of pocket to ensure my own health. I’m self-funder for all my (Dexcom) CGM transmitters and sensors ($2,600/yr, and I stretch one sensor to last at least 3 weeks and often 6 weeks).

For the short term, I’d get the Libre (get enough for at least 6 weeks).

If you have any questions, please don’t hesitate to ask.
Jim


#11

Exercise and a 10 pound weight loss could be beneficial in the early stages. Welcome to the group. Nancy50


#12

Do you have T2 in your family tree? Heredity is the largest risk factor. And there is also Latent Autoimmune Diabetes in Adults (LADA). It is a form of T1 that is slow to develop. Some people go for years with slightly elevated bg’s before facing full blown T1.


#13

Canada - the Abbott libre is approved in Canada. You will probably need to pay out of pocket but I would suggest you get your AGP for at least the next month. At that point there is no more guessing. OGTT and the rest will never tell the full story.

While getting you AGP, keep a detailed food log so you can correlate the two. Keeping a low carb diet will probably do more good for you than the metformin. With the AGP there will be no guessing.

Afrezza is not yet approved in Canada but if it was the best thing to do is get rid of the metformin. While it is Step 1 in the current ADA standard of care, the current approach is a “Treat to Fail” approach. Even worse its a planned “Treat to Fail” protocol expecting failure at each step.
Ralph DeFronzo who was the biggest proponents of metfromin 25 years ago said last year -
“The most waste in type 2 diabetes is to continuously put people on metformin and sulfonylureas (glyburide, glimepiride, etc.). These drugs have no protective effect on the beta cell, and by the time you figure out what you’re doing, there are no beta cells left to save.” – Dr. Ralph DeFronzo (University of Texas Health Science Center)


#14

Sorry but I need to make a point. Yes family history is a contributing factor to developing T2, but you can developT2 with out a family history,.
My history. I checked with 42family members on both my mothers and fathers side. I am the only T2. I am not overweight, I am active (runner) But I am well controlled.
There are no T1’s of any age.
But after 10 years mostly on diet and exercise only I think I can forget about developing LADA
Generalities don’t always apply.