Should I be concerned?

Type 1 and LADA New to Type 1 Diabetes
1

Hi, I am new here and I am looking for some advice concerning my current health issues. I am not diagnosed with any blood sugar conditions but I feel that it may be the cause of my ill health. Any advice would be very much appreciated :)

I am a 28 yr old female, at a healthy weight. My family has a history of type 2 diabetes. My great grandfather, who was thin his entire life was diagnosed as type two and had a leg amputated due to complications and my grandfather who ate terribly and was overweight was also diagnosed as type 2. My mother also tested borderline high for gestational diabetes 8 yrs ago but has not undergone any testing since.

I have read that there is a connection between reactive hypoglycemia and diabetes as well. At the age of 16 I began to experience crippling low blood sugar symptoms. I was never diagnosed with hypoglycemia but I would become ill shortly after eating any high carbohydrate food. It would start with a fast heart rate and it felt as though my heart was pounding very hard. About an hour or two later I would become extremely weak, shakey, lethargic and confused. I would find it hard to even hold my head up straight. It improved when I ate food but then the process would start again. As time went by there seemed to be nothing I could eat that would not induce symptoms. I went on a low carb, low GI diet and over time it improved untill I began to feel normal again. I had experienced these symptoms on and off since then but never as bad because I tried to eat healthy and be mindful of staying low GI. Recently I became rather relaxed about being low GI all of the time and it has greatly affected my health. I have had other symptoms when eating carbohydrates which concerned me because I have had days where I can almost never sleep because of the impact it has had on me and it has restricted my ability to exercise. Mostly I feel like my head is pounding horribly upon laying down. It has caused me to sleep in a chair for several nights at a time on and off. I know it is not typical of blood sugar symptoms and my doctor says it is probably stress but I have since been reducing my carbs and have noticed improvement but the symptoms are easily triggered again if I am not very careful. My blood pressure is fine by the way. Also about six weeks ago I had several days where I needed to pee so frequently it became extremely annoying (about 4 times an hour) I was not drinking more or eating more hydrating foods than I normally would. I also avoided drinking in order to stop needing to pee but it didn't help and I realised how thirsty I really was and eventually let myself drink. Luckily it didn't last to long.

About two weeks ago I decided to test my own blood sugar level with a glucose monitor just in case. I have tested high several times. I usually eat the same things every day in the same amounts at the same times but the levels are always very different. The readings have not been to bad overall but my blood sugar tends to spike after eating at night. During the day my levels are fine. Never going over 6.8 (120) that I have seen. I often find that I feel low during the day but most times I have checked it has been between 4.8 (86) and 5.3 (95) so I never actually test low ever.

My fasting level has been between 4.4 (80) 2nd 5.3 (95)

I got an 11 (198) for the first hour post prandial reading for a 45 gram carb meal of 1 piece of rye bread with a veggie pattie, salad and avocado and a second hour of 8.3 (150)

Another day I got 6.3 (113) 1st hr, 6.2 (111) 2nd hr and a 6 (108) on the 3rd hour and

9.8 (176) 1st hour and 8.2 (147) for the 2nd hour and all for the exact same meal!

Another time I had two slices of bread instead of 1 and the first hour I was 8.5 (153) and the second 7.7 (139)

I am so confused.

The last thing I tested was naughty icecream :D 54grams of carbs in it with a little almond butter.

Surprisingly, really sweet things don't have such a bad reaction with me, according to my levels.

6.1(110) 1hr post prandial but 7.7 (139) 2nd hr post prandial. Weird!

Should I be concerned about any of these levels? I am so confused!

Also does anyone know what should happen to blood sugar in a healthy person that doesn't have blood sugar problems if they overindulge in high carbohydrate foods?

For instance I had a fairly large amount of icecream over a week ago and I had full on pounding head, heart and lethargy with an inability to sleep. I tested my blood sugar four hours after eating and it was 8.1 is that normal when you overindulge?

Thankyou to whoever took the time to read my concerns, any advice you have to share is very welcome :)

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Most non-diabetic people don't go over about 120. I would suggest you get your doctor to do an A1C (average of your blood sugar for the last 3 months) and possibly an OGTT (you eat something sugary and then they test every so often for a couple hours.) If your A1C comes out in the pre-diabetes category (5.7-6.4) I would keep a close eye on it and keep your carbs down. If it is 6.5 or over it is diabetes and then you need to determine which type. If it is under 5.7 relax, stop driving yourself crazy and maybe check it again in 6 months.

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This study shows that non-diabetics can go as high as 160 (9.0) at about 45-60 minutes after eating.

Also keep in mind that home glucose meters can have an error rate of +/- 15-20%. So a reading of 11.0 may actually have been a reading of 8.8 - 9.4, and a reading of 9.8 may have been 7.8 - 8.3. Also, depending on the meter you use, some of them are exceptionally sensitive to having any food or other residue on your fingers (Freestyle meters are known for this) and some hand creams and such can also affect readings.

If you are feeling low but not testing low, then it sounds like you may be attributing symptoms to blood sugar that are caused by something else - or that your meter is reading higher than your actual blood sugar (and therefore may also be displaying false highs).

In regards to the ice cream, fat causes food to have a delayed absorption. It's not uncommon for ice cream or pizza to cause a delayed spike in blood sugar that doesn't happen the first hour or two but may happen three or four hours after eating or even later. So your blood sugar being higher at two hours compared to one actually makes sense.

I agree with Zoe's thoughts. I think you need some formal tests like A1c and a glucose tolerance test to determine if you have blood sugar issues.

4

Yeah, if you are concerned have an Oral Glucose Tolerance Test (OGTT) done. As Jen says, BGs for non-diabetics can have big spikes post meal, but the levels do return to normal fairly quickly, within 2 hours.

The numbers the OGTT actually specify are <11.1 mmol/l at 1 hour post meal and <7.8 mmol/l at 2 hours postmeal. If you're still above 11.1 after 2 hours, you're considered diabetic. This is after a 75g liquid carb load taken very quickly though.

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Thankyou Zoe, Jen and FHS for your replies :)

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Many of us try to stay under 7.8 (140) as there is some evidence that damage to the pancreas starts at that point. To be fair this evidence is indirect but it's the best we have as far as setting goals. By that standard you seem to have blood sugar issues that warrant further exploration. As mentioned by others a OGTT and A1C would seem to be in order. Regardless of the results, given your history, I would monitor my response to carby meals from time to time to see if things are getting any worse. If you can stay under 7.8 by eating low GI I would do that as it may keep things from progressing.

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I HATE the A1C test!

It is not accurate in many instances. For me, I was testing on my own for over a year and was up to almost 25 sticks per day. I was either spiking at 165 or close to or low into the 58 range. The "average" on the A1C always had my doctors saying I was not diabetic and two even suggested I get tested for Bipolar.

That test is what MOST doctors are using, in my opinion, as the end-all/be-all test for diabetes and it is not fair. Also, isn't there some proof now that the cells tested last longer in hypo vs. hyper people (or the other way around)??? While it can be a good TOOL in the overall shed of diagnostics, there is too much emphasis on it! IMO

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glucose meters can have an error rate of +/- 15-20%. So a reading of 11.0 may actually have been a reading of 8.8 - 9.4, and a reading of 9.8 may have been 7.8 - 8.3
I'm sure I missed something somehow, Jen, but your math seems off to me here.

First of all, meters are required to be no more than +/-15% by the FDA here in the US if I recall correctly, and I think it safe to assume this standard is worldwide.

15% of 11 is 1.7, so a reading of 11 could indicate a BG as low as 11-1.7 = 9.3 or as high as 12.7. Looking at your numbers it seems you subtracted 20% for the lower number of your range, and then subtracted 15% to get the higher number.

That's not a correct interpretation of what "+/- X%" means.

9

Judging by the data you've provided, I'd say there's a pretty good chance your one of us.

However, as many here have said, you need an accurate diagnosis. The best way to do this is an OGTT.

Given that you've hit 11 at 1hr from a 45g carb meal, there's a good chance you'll be up to or over that with a 75g OGTT.

With a family history of T2, you should not wait to get this resolved. At 28, with all the great technology we have today to treat this disease, the future for you is very very hopeful to have a healthy, happy, long (if a bit more annoying) life.

10

It is interesting that in examples of BG spikes you ate bread and ice-cream. Gluten and milk products can cause very strange symptoms in some people. Try to exclude them from your diet for a while and see if there will be any difference.

11

Most of your numbers are fine, but there are just a few that deviate far enough to raise a red flag -- 11 and 9.8, for instance, are far enough off the "normal" bell curve to be worth taking a good hard look at. Empirically, non-diabetic people mostly don't go much over about 6.7 or so. (Please don't write in and start reeling off exceptions, folks, I said "mostly".)

Your numbers are just far enough into the gray area that you really should get checked. As for which tests you should do, there are as many opinions as there are people. But OGTT and A1c are excellent places to begin.

12

It sounds like you're in the early phases of some type of diabetes so I would self monitor and find a good endo to follow you. Start to experiment with your diet and see how this affects your bg and as someone said gluten and lactose are two things that can affect bg a lot especially if you also have celiac or sensitivity to both.

I personally would get as much testing as possible: a1c, gtt, self testing, c peptide and antibodies. I went to a several doctors in the years before and much closer to my D crisis- none of them even considered diabetes, they tested for other possibilities, although the symptoms all pointed to D. If you haven't had a recent blood panel with cbc I would definitely do that too, to hopefully rule out other problems.

I also had hypoglycemia about 10-15 years before diagnosis- I don't think mine was reactive because it seemed to happen after long periods of activity without food, but I did also feel ill after high carb meals and I didn't test that much at that time. I had planned to do a gtt but then for some reason I decided it was just hypoglycemia due to lack of enough food. There is no diabetes in my family so that may have been one reason I didn't think that was the cause then. Type 2 often starts to do damage long before people even realize they have it so you can get on top of this early in the game- I think there are 5 million people in the US who have type 2 and aren't aware of it.

13

On this page you see a chart with both the American and International measures and you see that they are positively but exponentially correlated. You are quite right about those who tend toward lower blood sugars on average, if that is what you mean by hypo people, I would tend to agree, that the red blood cells last longer. It is true that those people with way higher average blood sugars would have their red blood cells die off and pop from trying to squeeze through arterioles with even having glucose stuck to them.

I think the HbA1c is indeed a good TOOL as you say even more so because it can prove to a doctor just how in accurate or not some people can be in how they report their control patterns to their doctors.

Being American your measures are not as close between the two but different concepts. At levels closer to normal where you are, they are close, but if a Cdn were to be told their HbA1c were 12, if they were to become confused and assume that means their average glucose was 12 they would be way wrong, as it would be through the roof at about double even the kidney threshold and they could become lackadaisical thinking that they are averaging 12, as if it means 12mmol. No, the glucose average and whether the red blood cells have glucose permanently suck to them which never come off means diabetics on the whole might have a higher incidence of anemia because of it.

I see your point, but I think it is an excellent tool, even though more likely to be misunderstood in Canada or Europe as opposed to the USA.

14

I think you meant that the average blood sugar and HbA1c are linearly correlated. The chart you referenced is dated and a revision has been made based on studies done by the ADAG group in 2008. The ADA has a good calculator for mapping between the estimated Average Glucose (eAG) and HbA1c based on the ADAG revision.

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Thankyou Dave, David, Dmitry,BadMoonT2 and meee for your responses. Sorry if I forgot someones name.