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What Does My Lab Test Report Indicate?
Question: I had a 2hour oral GTT today. While I realize the venous samples will give slightly different results, I used my glucomer throughout the test. I am not DM and have had post prandial blood sugars in the 40s. I am a 60 year old W female with lupus and arthritis. Hx of gastric bypass.
Fasting 91
. 5 hour 195
1 hour 273
1.5 hr 232
2 hr 174
2.5 hr 131...I was not able to have the test long enough for the sugar to plummet. Are you able to tell by these numbers diabetic, prediabetic, diabetic with hypoglycemia, other?
Fasting 91
. 5 hour 195
1 hour 273
1.5 hr 232
2 hr 174
2.5 hr 131...I was not able to have the test long enough for the sugar to plummet. Are you able to tell by these numbers diabetic, prediabetic, diabetic with hypoglycemia, other?
Brief Answer:
Glucose metabolism
Detailed Answer:
I follow what you are saying.
If this test was performed using the standard 75 grams of glucose, then the results show Pre diabetes at the 2 hour mark.
The normal range for the 2 hour post-challenge reading is less than 140. Anything between 140 to 199 is tantamount to Pre diabetes, while 200 and above is considered diabetes.
Your value is 174 which is also referred to as IGT (Impaired Glucose Tolerance).
The venous samples are accurate and represent the gold standard. Meter readings approximate the true venous glucose values but can read upto 20% on either side of the actual level.
After gastric bypass, a phenomenon called PGBH (Post Gastric Bypass Hypoglycemia) has been described. Yes I see you couldn't test longer to document a fall below normal but if you have compelling symptoms and the glucometer reads below 70, then it is very likely you have this condition. This requires comprehensive assessment, and there are treatment options like acarbose to be considered.
Glucose metabolism
Detailed Answer:
I follow what you are saying.
If this test was performed using the standard 75 grams of glucose, then the results show Pre diabetes at the 2 hour mark.
The normal range for the 2 hour post-challenge reading is less than 140. Anything between 140 to 199 is tantamount to Pre diabetes, while 200 and above is considered diabetes.
Your value is 174 which is also referred to as IGT (Impaired Glucose Tolerance).
The venous samples are accurate and represent the gold standard. Meter readings approximate the true venous glucose values but can read upto 20% on either side of the actual level.
After gastric bypass, a phenomenon called PGBH (Post Gastric Bypass Hypoglycemia) has been described. Yes I see you couldn't test longer to document a fall below normal but if you have compelling symptoms and the glucometer reads below 70, then it is very likely you have this condition. This requires comprehensive assessment, and there are treatment options like acarbose to be considered.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes I had the 75 mg dose. They let me go just a little longer than two hours hoping to replicate they hypoglycemia but unfortunately that didn't happen within the allotted time. I have heard of that post gastric bypass problem and asked the dr. about it...he brushed it off rudely and said "that only happens within a few weeks post-op"...which was in 2001. He also said "quit drinking juices and sugared drinks" (I drink neither). My morning blood sugars run around 70 or 80 and I feel ok, it's when I eat (tiny meal) that an hour later I feel the crash. Any advice appreciated.
What comprehensive assessment would you recommend and what is acarbose?
Thanks XXXXXXX LPN
What comprehensive assessment would you recommend and what is acarbose?
Thanks XXXXXXX LPN
Brief Answer:
Follow up
Detailed Answer:
I see you have a medical background. That should help you understand this complex phenomenon.
PGBH is a well recognised entity now. It can be quite bothersome.
A systematic evaluation of this requires testing similar to the type you had along the lines of a 'Mixed Meal test'. This entails sequential glucose checks every 30 minutes after a typical meal that induces your symptoms.
When a glucose reading falls below 55, blood samples for the following are drawn:
Glucose
Insulin
Pro Insulin
C peptide
Beta hydroxy Butyrate
Oral hypoglycemic agent panel
Insulin auto antibodies
IGF2
Then a 1 mg glucagon injection is given IM and blood glucose samples are taken at 10 and 20 minutes to see the glucose levels improve. Only then can one eat, unless of course disabling signs and symptoms of major hypoglycaemia occur.
Moreover, general tests and other special tests can be considered such as:
CBC
CMP
CALCIUM
TSH
FREE T4
SERUM CORTISOL.
A dedicated academic/ university endocrine center experienced in dealing with this condition will offer thorough assessment along these lines with slight modifications as per their protocols.
Acarbose is an oral medication that has been shown to be helpful in mitigating this problem
Follow up
Detailed Answer:
I see you have a medical background. That should help you understand this complex phenomenon.
PGBH is a well recognised entity now. It can be quite bothersome.
A systematic evaluation of this requires testing similar to the type you had along the lines of a 'Mixed Meal test'. This entails sequential glucose checks every 30 minutes after a typical meal that induces your symptoms.
When a glucose reading falls below 55, blood samples for the following are drawn:
Glucose
Insulin
Pro Insulin
C peptide
Beta hydroxy Butyrate
Oral hypoglycemic agent panel
Insulin auto antibodies
IGF2
Then a 1 mg glucagon injection is given IM and blood glucose samples are taken at 10 and 20 minutes to see the glucose levels improve. Only then can one eat, unless of course disabling signs and symptoms of major hypoglycaemia occur.
Moreover, general tests and other special tests can be considered such as:
CBC
CMP
CALCIUM
TSH
FREE T4
SERUM CORTISOL.
A dedicated academic/ university endocrine center experienced in dealing with this condition will offer thorough assessment along these lines with slight modifications as per their protocols.
Acarbose is an oral medication that has been shown to be helpful in mitigating this problem
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
In my research I am finding lots of dietary advice and am wondering in your opinion, until I hear differently, which one of the plans would be more suitable to my problem: ADA diet; DASH diet; Low Glycemic diet; something else?
And how many calories would you recommend for weight loss with height of 63" and wt. of 224, moderative activity?
Thanks !
And how many calories would you recommend for weight loss with height of 63" and wt. of 224, moderative activity?
Thanks !
Brief Answer:
Second follow up
Detailed Answer:
You will need to consult a dietician in person to create a plan individualised for you and the medical problem you face.
When you have symptomatic hypoglycaemia, you should ingest carbohydrates. Fifteen to 20 grams of oral glucose is typically sufficient. Glucose may be ingested in the form of tablets, juice, milk, other snacks, or a meal.
Otherwise, frequent (every three hours) small meals or snacks, consuming foods high in fiber, avoiding foods high in sugar, and a regular exercise regimen have been recommended . There is little or no evidence that any of these dietary changes are particularly beneficial. If dietary modification is not successful in reducing symptoms, some advocate a trial of alpha-glucosidase inhibitors to delay carbohydrate absorption and thereby reduce the insulin response to a meal. However, there are few data to support the efficacy of alpha-glucosidase inhibitors such as acarbose
Second follow up
Detailed Answer:
You will need to consult a dietician in person to create a plan individualised for you and the medical problem you face.
When you have symptomatic hypoglycaemia, you should ingest carbohydrates. Fifteen to 20 grams of oral glucose is typically sufficient. Glucose may be ingested in the form of tablets, juice, milk, other snacks, or a meal.
Otherwise, frequent (every three hours) small meals or snacks, consuming foods high in fiber, avoiding foods high in sugar, and a regular exercise regimen have been recommended . There is little or no evidence that any of these dietary changes are particularly beneficial. If dietary modification is not successful in reducing symptoms, some advocate a trial of alpha-glucosidase inhibitors to delay carbohydrate absorption and thereby reduce the insulin response to a meal. However, there are few data to support the efficacy of alpha-glucosidase inhibitors such as acarbose
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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