Help Interpreting Test Results. Could this be LADA?

[skwag]

Hi,

New member here, 42y male. I've been on a low carb diet for over a year now, which has taken me from feeling awful to just feeling fatigued.

I was hoping someone could help explain my recent 2hr glucose tolerance test results. I'll also include some other testing that might be relevant. Everything is in American units. Sorry!

July 2015

• Fasting glucose 94 (65-99)

Sept 2016

• Fasting glucose 97 (65-99)
• A1c 5.2 (<5.7)

Oct 2016

• Fasting glucose 68 (65-99)
• Fasting insulin 2.0
• 30 min after glucose challenge: Insulin 24.6
• 90 min after glucose challenge: Insulin 18.9
• 120 min after glucose challenge: Glucose 43

With glucose at 43, I felt a little sedated but not much else. I seemed mostly fine. I only learned a week later that it was low.
I'm not sure what to make of the hypoglycemia with relatively low insulin levels. Thanks for your thoughts.

 

[catapillar]

LADA is slow onset type 1 diabetes. This is a condition of high blood sugar caused by an autoimmune attack on the cells that produce insulin and therefore, low insulin production. An undiagnosed LADA or type 1 who is symptomatic X with fatigue won't get low blood sugar, it will be high blood sugar they present with.

None of your blood sugar results suggest high blood sugar.

Your insulin levels seem to be within the reference range of normal, if on the low side.

43 mg/dL is about 2.4 mmol/l which is very low for someone on no medication. Although, you were starting off from pretty low - did your blood sugar go up during the GTT test?

Do you have any other symptoms? Is there any particular reason you are low carbing - is that blood sugar related? Is there any particular reason that has prompted the testing?

Nothing about the tests suggests LADA or type 1. But perhaps reactive hypoglycaemia might be worth looking into? @Lamont D @Brunneria know a lot more about that than I do so they might be able to offer some thoughts on that as a possibility.

 

[Freema]

welcome skwag

 

[skwag]

Hi catapillar,

Thanks for the quick reply!

43 mg/dL is about 2.4 mmol/l which is very low for someone on no medication. Although, you were starting off from pretty low - did your blood sugar go up during the GTT test?

Do you have any other symptoms? Is there any particular reason you are low carbing - is that blood sugar related? Is there any particular reason that has prompted the testing?

Unfortunately, they did not take an intermediate glucose measurement. Just fasting and at the two hour mark.

I've got a ton of other symptoms! Before I started low carbing some of my symptoms included:

• Fatigue
• POTS - postural orthostatic tachycardia syndrome
• Neuropathy - mostly hand and feet numbness
  
• Headache
• Dehydration
• Thirst
• Frequent urination
• Dry skin
• Tinnitus
• Onset of eye floaters
  
• Cognitive Problems - Noise sensitivity, Irritability, Easily Startled, Poor Memory, Difficulty concentrating
• Dry eyes
• Increase in the above symptoms after eating significant amount of carbohydrates.

Now my symptoms are reduced but I still seem to be suffering from fatigue and cognitive problems.

I guess my latest Doc wanted to run the glucose tolerance test after I described my problems with eating carbohydrates.

 

[skwag]

Thanks Freema!

 

[Brunneria]

Hi and welcome @skwag

Have a rummage through the Reactive Hypoglycaemia area of the forum here:
http://www.diabetes.co.uk/forum/category/reactive-hypoglycemia.70/
and see if anything resonates

 

[Daibell]

Hi. Those blood sugar readings are very low and as @catapillar says do not suggest LADA at all; in fact the opposite. The @Brunneria comments look interesting as your blood sugar is 'abnormally' low.

 

[skwag]

Thanks for the replies.

I guess I was wondering if the hypos could be an early sign of LADA as discussed in this thread:
Untypical: LADA / postprandial hypos for yeeeears

Before I started the low carb diet, many of my symptoms were consistent with high blood sugar. Unfortunately I never got a glucose reading during that time. So a secondary question is could a low carb diet normalize blood sugars in the early stages of LADA?

Many years ago - 7 to 10 years ago, I can't remember - I bought a glucose meter. I found that 20 minutes after eating a bunch of candy, my blood sugar would spike above 200 and quickly fall back down. Everything else looked pretty normal. Based on this, I am assuming my recent testing indicates some kind of reactive hypoglycemia, even though we don't have a recent measurement of the initial spike in blood glucose.

One more thing I don't understand. The cases of reactive hypoglycemia I've read about seem to occur 3 and 4 hours after a meal and require longer glucose tolerance tests to identify. Whereas, I went hypo at the 2 hour mark, or possibly earlier. Maybe I just need to do more reading?

My ultimate question is this: Is it reasonable to ask my Doc for Type 1 antibody testing or will I appear crazy?

 

[chalup]

Doesn't hurt to ask and I don't think it makes you appear crazy. Maybe someone on the reactive hypoglycemic subforum would know more and could give you some insight.

 

[Brunneria]

RH comes on at different times for different people. Plus the amount of fat, fibre, carbs and protein in the food affect digestion time and RH time. So I am afraid that your 2 hr timings don't rule it out.

Fairly recently I had an RH hypo (my own stupid fault for eating Pringles! ) that came in at least an hour earlier than usual. Mine usually hit between 3-5 hrs, but definitely depend on food type, exercise and stress levels. Hope that helps.

 

[azure]

@skwag Did your doctor give you any diagnosis or explanation? What was their opinion on your test results?

 

[skwag]

@skwag Did your doctor give you any diagnosis or explanation? What was their opinion on your test results?

I see the Doc on Monday so she hasn't had a chance to tell me anything yet. A member of her staff called with the results yesterday, but didn't give me any sort of explanation.

 

[azure]

I see the Doc on Monday so she hasn't had a chance to tell me anything yet. A member of her staff called with the results yesterday, but didn't give me any sort of explanation.

Ok. That must be frustrating for you, but hopefully you'll get some answers from the doctor. I recommend making a list of questions you want to ask eg you could ask about the low sugars, RH, etc

 

[Lamont D]

There is condition called dumping syndrome akin to RH!
You need a prolonged OGTT.
You need a c-peptide test.
You need to start regularly testing.with a monitor. So you find out what happening.

 

[skwag]

Thanks for the suggestions @Lamont D !

Is there any consensus on which glucose meters are good, and at the same time use test strips that won't break the bank? This will all be out of pocket for me. Trying to read reviews at Amazon is making my head spin at the moment.

 

[Brunneria]

I would suggest the cheapest strips you can find.
It is a while since I went shopping for a meter, but the SD Codefree is consistently recommended on the forum on the basis of price.
There is another economic one. I can't remember the name, but @GrantGam1337 posted about it. Was it the Dario? Please correct me if I have mis-remembered.

 

[GrantGam]

I would suggest the cheapest strips you can find.
It is a while since I went shopping for a meter, but the SD Codefree is consistently recommended on the forum on the basis of price.
There is another economic one. I can't remember the name, but @GrantGam1337 posted about it. Was it the Dario? Please correct me if I have mis-remembered.

No you're spot on @Brunneria, it is the Dario meter I think they offer a 'Lite' version as well, which is slightly different and has cheaper test strips. They're just under a tenner for x50 I think. I've never seen or used one though.

 

[skwag]

You need to start regularly testing.with a monitor. So you find out what happening.

Got the glucose meter. In the attached pdf, I've plotted my glucose for 5 hours after three different meals. The latest meal with white rice spiked my glucose up beyond 200. I don't see any reactive hypoglycemia though.

What does this mean? Impaired phase 1 insulin response? Prediabetes?

 

[Lamont D]

Got the glucose meter. In the attached pdf, I've plotted my glucose for 5 hours after three different meals. The latest meal with white rice spiked my glucose up beyond 200. I don't see any reactive hypoglycemia though.

What does this mean? Impaired phase 1 insulin response? Prediabetes?

Neither do I!
But you do spike quickly.
You have a normal double insulin response going towards your spike.
Non diabetic RH ers do not have this.
It does look likely to be T2 tho!
But I could be talking rubbish!
Return to your GP and get a referral if possible.

 

[skwag]

You have a normal double insulin response going towards your spike.

Could you explain what this means and how you see it from the plots? I'm a little lost! Thanks