Help with results - A1C is 4.9 but c peptides are at 0.6

I have an appointment with my endo but not until October 2019 (one year from my last visit) because she said based on my A1C I’m fine and shouldn’t worry. However, right now I’m driving myself crazy googling so I figured I’d pick all your brains since you know so much more than I do.

I had gestational diabetes and continued to test after. I kept on getting told it would resolve and to just give myself time but 3 months later I still spike very high if I eat sugary things (one cookie will send me to 170/180 at one hour but I will go back to 90 at two hours). Out of concern I’ve gone lower carb and eat maybe 50g of carbs a day most days and have increased my exercise. My endo ordered an A1C which came back at 4.9 which was the same result I had back in September 2017 and told me I was all good even though I see these spikes.

After spending a lot of time here I ordered private labs for c-peptide and once those results came in I ordered more tests for antibodies (GAD/ZnT8/Insulin/IA2). My fasting glucose was 92 which is pretty average for me. However my cpeptide came back at 0.6 ng/ml (range bottom was 0.8) on a fast of 8 hours. I am still waiting the antibodies test but does this suggest LADA since my cpeptide is so low? Should I push harder for an appointment sooner (I called and they said that I am fine) or see another endo or am I just worrying for nothing?

The c peptide level is not meaningful at normal blood sugar levels. If your blood sugar had been 200 and your c peptide 0.6 that would be an entirely different situation… although it was slightly below the reference range, at that moment it was seemingly just the perfect amount to keep your blood sugar normal, so there’s no indication of a dysfunction or an inability based on that number alone.

If the antibody tests turn up anything it will warrant further investigation…

i think you are fine, you are low carb and would expect low insulin output and therefore lower c-pep. if you had a BG of 250 and that c-pep, then it would be a different story.

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Thanks - what should I make that I can’t really eat a single cookie without spiking? I honestly thought I would be pre-diabetic for type 2 diabetes since my endo said it was pointless to do an OGTT because I would likely fail (my OB wanted me to do it but my endo disagreed).

I don’t think you are T2 or are just very well controlled. your c-pep would be higher from insulin resistance, even though you are low carb. .
Your BG will rise with carbs and fall back in a few hours. If you spike over 250 and stay high and don’t fall back on a cookie…under 30g carb, you would need to get the rest of your tests and see if insulin is the option.

You’re in this never-never land where you don’t have a real diagnosis because you’re doing such a good job controllling bg.

I agree with your endo:Making a known diabetic take an OGTT would just be cruel.

Yea when I got the c-pep result is when I figured it’s more likely type 1 since it’s so low which is why I paid for the antibody tests. I’m scared to eat anything high carb really and try to mostly eat vegetables with some protein. If I eat a ton of protein I notice my 3 hour is higher than 1 hour (highest I’ve gotten at 3 hour is 154 when my 1 hour was 90) so I try to avoid that as well. I actually hate eating now since I hate living in fear of what my numbers will be.

That’s normal with protein it takes longer to digest.
I wouldn’t worry at under 250 till it’s sorted. put your meter down and chill. I know it’s hard. Just take your FBG of a morning a few times a week. It there is anything worth talking about, it will show up there first.

Your fasting c peptide doesn’t really enter the equation of why you’re spiking after meals…

There could be something going on there, but your c peptide level being slightly below reference with normal fasting bg isn’t indicative of it.

If your c-peptide level isn’t capable of elevating under a load then it would be significant, but the fasting level with normal blood sugar is not evidence of that…

It would also be significant if the c peptide was significantly high, even if blood sugars were normal as that could be indicative of early insulin resistance, but that’s not the case.

I’d recommend just waiting on the antibody tests and seeing what they show, then discussing your concerns with your doctor… certainly if you start seeing your fasting numbers start climbing up significantly… like 140+ it’s time to start aggressively pursuing some treatment…

And stay away from google… It will drive you crazy

here are the times

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The reason your A1C doesn’t reflect your spikes is because your BG comes back down quickly. BG’s need to be elevated for several hours to have any effect on an A1C.

I know something is wrong with me but trying to figure out what it is and since I had such low c peptides I thought perhaps it would be Type 1.

If you had high blood sugars at the same moment as that low c peptide, it would be a strong indication of type 1. Luckily, you didn’t.

There really isn’t anything wrong. You had GD that has resolved.
It is also normal to spike on a small amount of carbs, when you are doing low carb, It takes a few days to get the system balanced for higher carbs again.

This is the same person on low carb and high carb

The cookie spike was actually after I went back to “eating normally” for 6 weeks after my delivery. I didn’t bother to check my sugars after meals until my 6 week post partum check which is when I was supposed to schedule my OGTT (supposed to take it at 3 months but endo said not to) and I was curious how things looked since I failed my original OGTT in spectacular fashion.

I switched back to low carb after seeing two crazy spikes (the one cookie then I tried again with 1/4 pumpkin muffin which sent me into 195 range after a brisk 30 minute walk). My endo told me to continue to watch my carbs and offered to put me on metformin when I told her about these spikes but she didn’t think I “needed” it.

It appears from that statement that your endo does consider you to be a diabetic but a very well controlled one. If you can continue to control your BG’s without medical intervention then that is safer but if your spikes start going up into the mid 200’s or so then your endo would probably be amenable to trying medications.

Many non-diabetics spike up into the 180’s after meals particularly if they are eating higher carb so I can understand why your Dr. isn’t really worried at this point but if you start experiencing symptoms of hyperglycemia like extreme thirst, frequent urination, lethargy, or sudden weight loss then get a hold of your Dr. immediately because that is serious. Otherwise I personally would just continue to watch what I eat, exercise plenty and monitor my BG’s if I were you and try not to worry too much.

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This simply could be early stages as well. Just hypothesizing ok, but since you are producing insulin, your body could just be adjusting as best as possiible. Symptoms of irritability, extreme tiredness, thirst, bathroom trips more than usual are signs to watch out for. Especially the tiredness. It’s the body’s natural way of trying to metabolize the sugar. Your A1c’s are certainly normal which is good. The antibody tests do take a little longer, but they would be very clear on what is going on with you. Cases of gestational diabetes do go back to normal after birth, but not all cases. Some cases remain. I would stay away from flour, rice, pasta, and potatoes. I would drink bone broth first thing in the morning. Sparkling water too. I would not eat breakfast until 10 am. Eat fruit separately as snacks. Eat natural foods only. Squash, beans, meat, honey as well are good for digestion. You’re dealing perhaps with a metabolism issue, digestion issue. But changing diets is tough. But this is just my opinion. I’m certainly not telling you what you have to do. I’m just giving you alternative thoughts and ideas that may help if it does turn out to be headed in that direction.

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