Great post 2hobbit1!
There was a similar post on here when I was first figuring out my own situation, and it was so helpful to have suggestions about how to approach some home testing!
Best wishes!
marty1492
You might also want to try the pure glucose home OGTT, by using the soda equivalent of 75 gms. See if you can find a sugar sweetened one not just HFC syrup. The fructose plays a little different from glucose. Also with a straight high sugar hit you do not have to be concerned with the complications of the fat and protein altering your rise. Then the timing and curve will fit what your doc is used to seeing.
It's a little easier to get down quickly if you let it go flat before you start.
Thanks for the tip. I just found Hansen's Pure Cane Soda at Whole Foods (although I have to drink 2 12oz to get to 75g!). I will certainly let it go flat first. I remember how hard it was to drink the super sweet stuff when I was pregnant.
Question - Does it matter what time in the morning I do the home glucose tolerance test? I would like to do it before I see the doctor next week, but I don't have any morning with three hours before when I typically get up and when I need to be out doing things. Would it be okay to get up several hours early in order to get the results?
PS My pancreas is being very contrary. After months of being very careful in order to keep my 1 hour number under 140, now I can't GET my number over 130! I finally ate a scoop of ice cream and got a one hour number of 178, but at two hours I was down to 114. I think my pancreas just likes messing with my mind. I'm struggling to stay strong about seeing the doctor - hence the desire to do the home glucose tolerance test.
Not to throw a monkey wrench in your plans, CQJ, but if you are doing the OGTT at home to prove something to your doctor, it may not work. Doctors tend to have little faith in tests done at home. I even gave up on doing home A1C tests (which are very reliable) and giving the doctor the results because they still wanted "lab results". Now if I do one it's just for my own benefit.
It is done after a minimum of an 8 hour fast. You can do a fasting, chug the "beverage" then take a timer with you and set it to ring every hour. A FS takes a few seconds to do so you do not need to be home for the process. Your meter will keep the log of the time and number and you can transcribe it when you get back home.
I have used a kitchen timer on a rope, a sport timer, an alarm watch anything you can set for one hour intervals will do.
CQJ- I would forget the home glucose tolerance test. Stress will increase your BG too- sometimes dramatically.
The blood tests you need are for the antibodies and c-peptide. When you have LADA (undiagnosed), you are gradually losing insulin, but you still have some that actually works now and then. When you eat, there may be more carbs than what your body can use immediately which will result in a BG spike (178). But because you still have some insulin, the insulin will bring the BG down like a non-diabetic. This is probably where you might also see the reactive hypoglycemia too. Hope this makes sense.
You may be in this phase for years. I went 2 years between LADA diagnosis and insulin- probably not a good idea now, but I didn't know any better then.
If you ask the doctor specifically for the tests you want. The doctor might do it just to end the discussion and prove his or her opinion (or not). When I first asked for a diabetes test, my GP thought I was crazy. (Oh well, I wanted a test to rule it out.) I expected a glucose tolerance test, but she took blood sample and got an A1c around 10.7.
Yes, I suspect as much. However, I would like to convince myself that I have a problem so that I can be more convincing when talking with the doctor. If I am waffling about whether I really need to do anything about my blood sugar than I am more likely to be pawned off by the doctor.
Thanks - I have discovered that about stress. I hope to push to get the antibodies test and c-peptide test from the doctor. I just worry that the doctor will claim the tests aren't justified since I can keep my numbers in a good range. I haven't completely decided if I am going to do a home glucose tolerance test (still haven't determined a good day), but if I do it and get high results then I will feel more confident in pushing the doctor to do those tests. Since my numbers are behaving very well right now (I ate 40g of carbs at dinner last night and my one hour number was only 138), I am feeling like there is no need to go to the doctor afterall - that I don't have a problem and I'm making a big deal over nothing. However, I have made the appointment and I am going if only to appease my husband (who likes to point out that the next time my sugars are high I will flip out again). I appreciate the advice!
Thanks, I will consider that. However, I am a teacher, so during the week it won't work (I'm not comfortable stopping class to take my blood glucose, even if I thought I would be a competent teacher after drinking all that sugar on an empty stomach). The weekend is a possibility if it rains, but typically I am running my kids around outside all morning and, again, have trouble stopping what I am doing to check and need to not be a horrible parent but snapping at my kids for no reason (all the witnesses, don't you see :-) ). I'm still trying to figure out a way to get it in, and since there is a chance of rain on Sat, I may get my chance.
Makes sense!
Well, I woke up this morning to rain, so I did the Home Glucose Tolerance Test. I took my fasting number, then drank 20 oz of Hansen's Creamy Root Beer (sweetened with pure cane sugar). The experience has not given me any confidence that I am not making a fuss out of nothing and, if anything, I am more confused. Here are my results:
fasting 87
1 hour 184
2 hour 76
According to those results, I not only am not diabetic, I'm not even PRE-diabetic. So, given that data I would conclude that I am making a fuss over nothing and will feel rather sheepish going to the doctor on Tuesday.
However, these results are mostly just confusing. For one thing, I have not seen a number as low as 76 (or even as low as 80!) since I started testing. My fastings are always in the upper 80's and 90's. So my insulin really went to town on this experiment. Also, last night at dinner (consisting of a tossed salad with low-carb dressing, and a dish of mainly cauliflower and bacon) I was very hungry and ate one of the rolls my husband had made for himself and the kids (about 25g of carbs). At one hour my number was 134 and at two hours it was 166. So eating a single roll gives me a higher number at 2 hours than 20oz of straight sugar?
CQJ- Creamy Root Beer would be a "fast carb." Your response may be normal or if your BG continues to drop, it my be a typical pattern for reactive hypoglycemia.
It's all about timing. When you ingest more fast carbs in a short amount of time, your BG spikes. When the insulin kicks in, the BG drops rapidly. (Eating high fat carbs like nuts or cheese will slowly raise BG. It will not spike.)
My nutritionist / CDE always advises me to eat a nutritious snack 15 minutes after I treat a low BG (with a fast carb) to stabilize the BG so it does not drop too low within the next hour- just like what you experienced.
When you eat a restricted low carb diet, it is difficult to say whether or not you are diabetic. If you do have LADA, you can control your BG for a long time on a strict low carb diet. You do have insulin. The antibody test and c-peptide tests will be better immediate indicators about what is going on.
After my diagnosis, my A1c dropped from around 10.7 to 6.0. Just because I got down to 6.0 did not mean that I was no longer diabetic. It meant that I was doing a great job with low carb meals and exercise. Gradually over time -in my case 2 years- the low carb diet and exercise were not enough to maintain good control. It took that long to diagnose me with LADA.
Go to the doctor because you have concerns. Do not worry about feeling stupid. Whether you are diabetic or not, it is not good for your health to worry about every BG reading. Just do the best you can to maintain a health lifestyle.
Good luck.
Update: I went to the doctor this morning and she took me seriously. (It helped that I hit 200 last night after adding a slice of bread to my regular dinner.) She told me (that now makes doctor #4) that my case is a question of when I am diagnosed with diabetes, not if.
I have an appointment next week to do a fasting sugar, an A1C, and a c-peptide test. I also have a prescription for metformin. The doctor convinced me that I want to delay a diagnosis of diabetes for as long as I can (assuming I can keep my sugars under control with diet, exercise, and metformin). So, I hope to learn whether my low carb diet has improved my A1C as well as how my c-peptide measures (i.e. am I mostly insulin resistant or mostly insulin deficient). I am also curious to see if the metformin has an effect. I'm not exactly sure how it works, but she told me it doesn't cause hypoglycemia.
What rationale did the doctor give for delaying the diabetes diagnosis? Is it the general higher blood glucose levels than you experience now? Or does it have something to do with insurance or legal concerns? It's not like you would fall off of some metabolic cliff when they tag you with diabetes. It's more of a gradient. I don't get it.
By the way, I think it's so smart that you've been minimizing carbs to keep your BGs in better control.
Metformin works two ways, it down regulates your liver so it doesn't dump extra glucose into your system as easily as before and also increases your tissues sensitivity to insulin, as in decreases insulin resistance.
That assumes that you are a type 2, and you may not be. You really should get the full panel of auto antibodies along with the c-peptide. Getting a correct diagnosis early rather than later can make a big difference in how you get treated. That can make a big difference in how much pancreatic function you may be able to preserve.
If your primary does not want to go there then you might want to get a referral to an endo who knows about T1/LADA. If you get worked up and are T2, then diet and oral medications will work for a long time. But if you are LADA, then a different therapy may be better at keeping your pancreas working longer.
Getting a correct diagnosis also makes a huge difference in how much coverage you will get via insurance.
Her argument was that it would negatively effect things like life insurance and getting long term care. In addition, as long as my numbers are still acceptable there is nothing the diagnosis would change.
I feel this is true if I am Type 2, but not so if I am some kind of type 1/LADA. I decided I would see what my new A1C is after low carbing for 3 months as well as the c-peptide. If the c-peptide is very low I will feel differently. However, since my pancreas is so erratic, I feel there is a 50/50 chance it will come back as normal either way. So, I am waiting until I get my results to decide what to do next.
I agree. However, I want a better feel for the likelyhood I am not Type 2 before I start insisting on things. Once I get the results from the c-peptide and latest A1C I will have a better idea of where I stand. If the c-peptide is low and/or the A1C is high (after having eaten very low carb for the last 3 months), I will likely insist on a referral to an endo and/or more testing.
I did learn the hard way that I need to be my own self-advocate in my healthcare, but I still find it hard to be pushy (especially to a doctor). (When I was pregnant with my first child I started complaining about excessive fatigue around 5 months. The advice was to try and get more exercise. I did this and felt even worse. By 6 months I was complaining about being unable to sleep because I would be thirsty and get a drink only to need to pee before falling asleep and then needing another drink before falling asleep. I was told that pregnant women produce extra saliva and this was probably the issue. When I counted the 22 8oz glasses of water I had drank between breakfast and lunch, I was pretty sure the information I was given didn't make sense. At 7.5 months when I failed the gestational diabetes screen and then the glucose tolerance test, the doctor's were extremely surprised. I had one doctor take a look at me and say, "What did you do? Have you been eating too much ice cream since getting pregnant?" Needless to say, I had a new set of doctors for pregnancy number 2.)
CQJ - I was misdiagnosed as a Type 2 diabetic at age 30. It took a year and a half and a trip to the Mayo clinic to finally find out that I have LADA. I suspected it after doing so research. I also have 3 other autoimmune disorders and had a feeling that it wouldn't be surprising to have LADA in my case. My endocrinologist at the time said I just wasn't taking medication and eating as I should. He said LADA was rare and not to worry about it. He called me to apologize after I got the diagnosis from Mayo. He felt like a complete idiot because he did his residency with the same doctor who diagnosed me!!! Needless to say, I fired him and found a great endo! I'm now 34 and pumping insulin. I have a new lease on life. I encourage you to fight like heck to get the tests you need! If you do have LADA, the research shows that it is important to start on insulin early so that you can keep as many beta cells as possible! Go into your GP or whoever you see, armed with research and the tests you want done. You absolutely HAVE to advocate for yourself. Our health and our reputation are the two things that we have when everything else falls apart. Health is a blessing and it's important to do everything we can to keep it!!
I found that the long term care insurance I could buy as a T1D was unaffordable. Your doctor's right about that.
If I were you, I'd be curious about the blood antibody tests cited upthread.