Totally bewildered by my doctor.

[Jamesuk9]

Hi, I'm James from South Wales and was hoping I could ask for some advice that has been troubling me for some time.
In September 16 I became ill and underwent some blood tests at my doctors which all came back as normal I'm told but was asked to do a a1c test after my fasting blood sugar was elevated. I wasn't told what level it was at, I found that out at a later followup visit (6.7) fasting. The a1c came back at 5.6 which I'm told was normal. So I moved on at the time.
During the followup visit I asked to know the results and was assured I was not diabetic based on the a1c.

I did my due diligence as I have learned never to accept what a doctor said without researching and realised that the fasting level was within Prediabetes range so I went and bought my own meter and started testing at home.

What I noticed that during a normal overnight fast I would get anywhere between 5.2 and 6 so I did an at home glucose tolerance test which I passed. I then decided that I wasn't satisfied, it was too close to call for me and made many changes.

I have since lost around 20lbs taking my BMI from 25.2 to 22.5 and my overnight fasting numbers are now around 4.9 to 5.5 but at 5.2 most of the time. But what I have noticed is that the longer I fast, the more the fasting number increases. On an 18hr fast I can be at 6.5-6.7 before I eat. I haven't fasted any longer as I fear the number increasing further.

Also, I did another tolerance test recently and it was too close for comfort, around 10.5 at 1 hour and same at 2 hour, returning to normal in just under 3 hours.

Is it possible that as I have been on a seriously restricted carb diet that my tolerance to glucose made this second at home test worst than the first one? As my fasting numbers are acceptable all the time unless I go too long without eating and then they climb.

I want to go back to my doctor, but as he dismissed me as having no issues based on a1c, I want all the facts beforehand.

I've always been a once a day eater, loading up on carbs every evening to keep me sustained until the next night. I don't really enjoy eating, I just made poor choices out of convenience.

My diet now is 2 smoothies breakfast and lunch and a small evening meal.

Today for instance, when I woke up I was at 5.0 and 2 hours later with no breakfast I was at 5.9 and an hour later at 6.9. I then ate a yogurt and an apple and was at 5.4 an hour later.

It's so confusing, I clearly have issues, but my doctor doesn't take them seriously.

Thanks for listening.

 

[azure]

Hi @Jamesuk9

The higher number from fasting longer could be due to your liver releasing glucose into the blood due to,you having not eaten.

What do you mean by saying you did a glucose tolerance test at home?

 

[Jamesuk9]

Hi thanks for responding. Nothing scientific as my doctor refused to send me for one. A simple bottle of lucozade classic from the local shop.

 

[CherryAA]

HI James, I cannot remember where I saw this but whilst researching lchf and ketogenic diets i did see something which suggested that if you tried a glucose tolerance test direct from a ketogenic diet the results would be worse than expected because your body has to Retrain itself to take the carb load .

If i was in your position , i would be asking myself what exactly you want the medical profession to do for you. If you do have some insulin resistance it is clearly at a very early stage, so it would be madness to start taking pills. thus your treatment is diet. you can get all the advice on that you need on here, plus dietdoctor.com, including switching from carbs to lchf living , you can learn about both fasting and its effects from googling dr fung .

A morning rise is actually normal even for non diabetic people , though the extent of it may get worse as one moves towards diabetes . Again you can confirm that in google.

My personal opinion for what its worth is that you are overstressing on this which a good read of the above resources would probably put your mind to rest and also provide the pointers to your next steps .
GOOD LUCK

 

[bulkbiker]

As @CherryAA says above if you have been low carbing then your body can have a kind of toxic shock reaction to a sudden influx of carbs. I think it is recommended that you eat carby meals for 2 or 3 days before doing a OGTT if you are a low carber. This is the main reason why I don't want to do one. If you are really worried I would ask the surgery for another HbA1c test to see how you are doing. I just call up and book myself in for a blood test without asking the doc first. As it's the only time ever visit the surgery I figure they owe me 2 tests a year...

 

[Jamesuk9]

HI James, I cannot remember where I saw this but whilst researching lchf and ketogenic diets i did see something which suggested that if you tried a glucose tolerance test direct from a ketogenic diet the results would be worse than expected because your body has to Retrain itself to take the carb load .

If i was in your position , i would be asking myself what exactly you want the medical profession to do for you. If you do have some insulin resistance it is clearly at a very early stage, so it would be madness to start taking pills. thus your treatment is diet. you can get all the advice on that you need on here, plus dietdoctor.com, including switching from carbs to lchf living , you can learn about both fasting and its effects from googling dr fung .

A morning rise is actually normal even for non diabetic people , though the extent of it may get worse as one moves towards diabetes . Again you can confirm that in google.

My personal opinion for what its worth is that you are overstressing on this which a good read of the above resources would probably put your mind to rest and also provide the pointers to your next steps .
GOOD LUCK

Thanks for your reply. I haven't been well for several months after my BP meds messed my stomach up and health anxiety took over.

I guess I just wanted my doctor to take my concerns seriously but it is evident that they don't as they even refused a referal for endoscopy given that there was no melena or vomiting involved just gastric and esophageal pain. Most of it has resolved now but it's taken months and a lot of weight loss due to my fear of eating and causing more pain.

I've managed to get them to run blood tests, which I'm told were pretty much normal and inflammation markers didn't show anything either. I had low red cell count at the time but again, nothing he was concerned over.

I think he has just dismissed me as a hypochondriac to be honest.

Anyway, I've cleaned up my diet somewhat and got a little obsessed with daily walking and am getting stronger but still not right.

 

[Bluetit1802]

I agree that you are over stressing. Your fasting test of 6.7 was most likely due to a liver dump plus stress. This is why they are no longer used for diabetes diagnosis. There are too many factors outside our control. The HbA1c and the OGT are the two diagnostic tests.

You are quite right that an OGGT can give a higher result if carb consumption has been seriously restricted in the few days beforehand as your pancreas has gone to sleep. It is best to eat normal carbs for 3 days or so before a test to give your pancreas chance to catch up with things.

As you have a meter I would use it to test your meal time glucose patterns. Test before you eat and then at an hour and 2 hours after first bite. If you are still high at 2 hours, keep testing half hourly until back to base.

It is normal and common for our livers to dump glucose in times of fasting, exercise, stress, illness, pain and other stuff.

 

[Jamesuk9]

I agree that you are over stressing. Your fasting test of 6.7 was most likely due to a liver dump plus stress. This is why they are no longer used for diabetes diagnosis. There are too many factors outside our control. The HbA1c and the OGT are the two diagnostic tests.

You are quite right that an OGGT can give a higher result if carb consumption has been seriously restricted in the few days beforehand as your pancreas has gone to sleep. It is best to eat normal carbs for 3 days or so before a test to give your pancreas chance to catch up with things.

As you have a meter I would use it to test your meal time glucose patterns. Test before you eat and then at an hour and 2 hours after first bite. If you are still high at 2 hours, keep testing half hourly until back to base.

It is normal and common for our livers to dump glucose in times of fasting, exercise, stress, illness, pain and other stuff.

Thanks I've been doing that after carbs and tend to hover around 7.0 at an hour, peak at around 9.0 and back at 7-8 at 2 hours. Always back below pre meal check by 3 hours, sometimes sooner. But then an hour or 2 later it climbs on its own again for no reason.

 

[walnut_face]

.


I've always been a once a day eater, loading up on carbs every evening to keep me sustained until the next night. I don't really enjoy eating, I just made poor choices out of convenience.

My diet now is 2 smoothies breakfast and lunch and a small evening meal.

Today for instance, when I woke up I was at 5.0 and 2 hours later with no breakfast I was at 5.9 and an hour later at 6.9. I then ate a yogurt and an apple and was at 5.4 an hour later.

It's so confusing, I clearly have issues, but my doctor doesn't take them seriously.

Thanks for listening.

Carbs are metabolised into sugar. You might like to do some more research and that might cause you to make some dietary changes

 

[Jamesuk9]

Ultimately, all the gp was interested in was the a1c and nothing else. Yet everything I read suggests this isn't a good diagnostic tool.

 

[Jamesuk9]

Carbs are metabolised into sugar. You might like to do some more research and that might cause you to make some dietary changes

Thanks, yes I'm now aware and limit them severely. Given up bread and sugar and restricted potato to a very small amount if it all. I don't eat rice or pasta so that wasn't a concern.

 

[azure]

I echo the above @Jamesuk9 If you were eating a restricted carb diet, then that could have affected your homemade glucose tolerance test, as can stress.

Your doctor has said all's ok for now, so just keep monitoring things but in a non-stressed way, and then maybe have a repeat HbA1C in a few months.

Your results don't sound bad. Non-diabetics can go up to 10 or so after a meal, and I've tested non-diabetic friends at 7 two hoyrs after a meal.

 

[Brunneria]

Hi and welcome

Just a couple of things in response to your post.

Firstly, my fasting blood glucose tests in the morning, are proof of absolutely nothing, except to show that my fasting blood glucose hops about like a pea on a drum. From opening my eyes, to going through my morning routine, to the point at which I eat breakfast. Seriously, my readings can vary from the 5s to the teens. Now, I am diabetic, and you don't seem to be, so your range is probably smaller. But I strongly advise you to run half a dozen tests one morning - on wake up, and then every half an hour for a few hours, until you eat lunch. You will probably see that a single fasting blood test is like pinning the tail on a donkey. Add in the natural variations and inaccuracies of home glucometers (+/- 15% on every test), and you will see that your figures are less useful than you may have thought.

In case you are wondering what causes these fluctuations, it can be exertion, stress, sleep, lack of sleep, hunger, your liver deciding to be helpful and release glucose into the bloodstream... only some of those have anything to do with being pre-diabetic.

Secondly, if you are going to run a home glucose tolerance test, then I suggest you read up on it very carefully, and do it exactly as would happen at the surgery. Timing. Quantity of glucose (in grams). Time taken to glug the drink in minutes. Precise timing of subsequent blood tests. Amount of exertion. etc. etc. It is the only way you will ever be able to make a personal comparison with 'official' stats - and even then, your doc will discount your findings out of hand. They always do. The assumption is that you won't have done it 'properly'. It won't matter whether you did or you didn't. They will assume you got it wrong.

Thirdly, everyone, diabetic or not, experiences something called 'the last meal effect'. It is where your body gets used to dealing with the amount of food and carbs that you have been eating for the last few days. And it then expects you to eat the same today, and expects that you will need the same amount of insulin to cope with those carbs. Basically it uses the requirements of the last few meals to predict and get ready a certain amount of insulin. Then when you eat, that insulin is conveniently available.

But if you have been eating 2 smoothies (what is in them, by the way?) and a light evening meal for a few days, and then dump in a whole bottle of lucozade, your body isn't prepared. It will do its best, and it will catch on fast, but it won't react as quickly, or as efficiently, as if your last few days had involved chugging lucozade.

So basically, for anyone who eats 'reduced carbs' or a restricted diet, it is very important that they sort their 'last meal effect' out BEFORE they do a glucose tolerance test. The standard advice is to eat 200+ grams of carbs a day for at least 3 days before the test. Personally, I would suggest doing it for a week. That way, the test result is comparable with the general population, and can be interpreted using standard NHS guidelines.

Hope that helps.

 

[azure]

Thanks, yes I'm now aware and limit them severely. Given up bread and sugar and restricted potato to a very small amount if it all. I don't eat rice or pasta so that wasn't a concern.

That could be what gave you the glucose tolerance test that worried you then.

If it was me, I'd concentrate on my general health (you mentioned previous problems), reduce the blood sugar testing, and go back to the GP in a few months to put your mind at rest.

 

[azure]

I'd also add that it's always a bad idea to diagnose yourself. If you have ongoing concerns, see a doctor for proper tests and advice.

 

[Jamesuk9]

That could be what gave you the glucose tolerance test that worried you then.

If it was me, I'd concentrate on my general health (you mentioned previous problems), reduce the blood sugar testing, and go back to the GP in a few months to put your mind at rest.

Thanks, that makes perfect sense. I think my anxiety stems from the amlodipine I was taking that gave a multitude of side effects that just got worst. I did have excessive urination, neuropathy, general lethargy and aches and pains but when I ceased taking them and modified my diet they resolved too...

I just can't help wondering, and yes the blood meter has become an obsession I don't need right now as nothing I eat or drink is sending my numbers into the stratosphere but do give me the impression that there are issues.

You are all right that all the doctor would do is suggest lifestyle and diet changes which I am doing anyway.

It's just not knowing, the anxiety is always there.

All stems from the fear of eating and the stomach pain I experienced that drove it and this on top has just made me fear eating anything to be honest.

I'm not doing myself any favours for sure.

Thanks so much everyone for the sound advice and responses.

 

[azure]

I wish you all the best @Jamesuk9 You sound like you're very switched on to things that affect you, and that will stand you in good stead.

Yes, once you start being aware of something you're not usually aware of (blood glucose levels in your case), it can cause anxiety. Perhaps just do an occasional test to put your mind at rest.

If the fear of eating is affecting you adversely, maybe your doctor or nurse could help with that. I can understand your fear after your experience. I can't offer any advice except to be kind to yourself.

Wishing you good health

 

[douglas99]

If you low carb, it will push your hba1c down as well, so regardless of anything, you would expect to see a good reading if you go back in a few months.

These are the figures for BG

http://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html

 

[Jamesuk9]

I wish you all the best @Jamesuk9 You sound like you're very switched on to things that affect you, and that will stand you in good stead.

Yes, once you start being aware of something you're not usually aware of (blood glucose levels in your case), it can cause anxiety. Perhaps just do an occasional test to put your mind at rest.

If the fear of eating is affecting you adversely, maybe your doctor or nurse could help with that. I can understand your fear after your experience. I can't offer any advice except to be kind to yourself.

Wishing you good health

Thankyou.

Is it now common practice to use only a1c as a predictor? And then OGTT if that is a concern.

I just don't get why my gp dismissed the suggestion out of hand based on the a1c and the fact that I'm not overweight and am active, which to me is totally unacceptable to apply stereotype to risk.

At 5.6 I considered it borderline, he considered it normal and worthy of nothing more than another check in 12 months.

 

[azure]

I'm not sure @Jamesuk9 I imagine it would depend on the doctor. We commonly see HbA1C used here, but OGTT is also used.

If you're really not happy with what you've been told, you're entitled to request a second opinion. But if you do have another test or an OGTT discuss with your doctor what diet you should eat beforehand so you get an accurate result and not one skewed by you limiting carbs.