What next?? Nurse wants a GTT

[WelshSailor]

I’ve posted a few times over the last few weeks and received excellent advice and support.

Long story short, I’ve been low carbing for 5 years since my brother was diagnosed T2. I did it to be his accountability buddy but he couldn’t stick with it. For me on the other hand, it really allowed me to come to peace with food and I felt so well I stuck with it. I had an A1C at that time at my request, which iirc was around 5%. My brother is very unwell with his diabetes and it’s scared me so for the last 5 years I’ve done one fasting and one post meal finger prick on the first day of every month - never an issue - small monthly variations but no discernible upward trend.

Five weeks ago I had a completely uncharacteristic high carb breakfast of porridge and honey (I know, what was I thinking), and then even more stupidly went to my 65 year well person appt. Random BG of 8.8 about 45 minutes after the porridge. So I monitor it at home for three weeks, 8 times a day. Highest reading I get is 5.8, mean is 4.4 and FBG usually low fours, high threes. When I go back to see the nurse she tests my wee and of course it’s full of ketones. As I would expect as I also do intermittent fasting. I don’t do keto as I eat a lot of veg but my diet is completely lacking (or deficient in her view) of starchy carbs and snacks. She instructs me that all I’m doing is eating to cheat the test, that I DO have diabetes, I’m just hiding it from myself and everyone else. I get handed the eatwell plate and told to eat three meals and two snacks a day (normally I eat two meals, zero snacks). I’ve had an uneasy relationship with food all my life and I’ve worked really hard to get to a place where food should be high quality fuel and not my security blanket.

I ignore this advice, carry on as normal and agree to an A1C to put the matter to bed. Which came back today at 5.1%. However, rather than settling things, it seems to have riled her even more and she insists that if I ‘persist in concealing my diabetes by refusing to follow standard medical advice’ then the only solution to open my eyes to the problem is to have a GTT. I’ve refused saying of course it will be high given my normal eating pattern, and I’m not prepared to make myself unwell for this test.

I just want to walk away now and get on with my life but she says I’m scared of the GTT because it will force me to face facts. I’m not stupid, I realise I have a family predisposition, I see how very unwell my younger brother is and I do want to be responsible. But I don’t want to do this test. Tell me honestly (I know you can’t diagnose me or tell me what to do, but I’d really value some insights) - am I bring irresponsible? Am I refusing to face facts here? Do I need to overhaul my diet (she also says that LC will have made insulin resistance so much worse that I will have done a lot of damage already). Im so upset and worried.

 

[Goonergal]

persist in concealing my diabetes by refusing to follow standard medical advice’

That’s a very odd opinion to say the least. The woman sounds dangerous.

Am I refusing to face facts here? Do I need to overhaul my diet (she also says that LC will have made insulin resistance so much worse that I will have done a lot of damage already)

I’ve yet to see any evidence of low carb making insulin resistance worse. Your blood sugars are obviously under control given your A1C result. Why would you want to change?

Your body, your choice. If you don’t want a GTT you don’t have to have one and to be honest the A1C is the standard for diagnosing diabetes. Maybe if you were eating the ‘eatwell’ plate you’d have a diabetic A1C, maybe you wouldn’t, but if you did, then reducing carbs would help with that……

 

[Antje77]

I just want to walk away now and get on with my life

Sounds like a very good plan!

Your hba1c is completely non-diabetic, and so are you daily readings including the 8.8 within an hour of eating porridge with honey.

If you ever feel you need a nurse again, find another one, this one is not doing your mental health any favours.

Your monthly test sounds like a perfectly sensible approach to me.

 

[filly]

I’ve posted a few times over the last few weeks and received excellent advice and support.

Long story short, I’ve been low carbing for 5 years since my brother was diagnosed T2. I did it to be his accountability buddy but he couldn’t stick with it. For me on the other hand, it really allowed me to come to peace with food and I felt so well I stuck with it. I had an A1C at that time at my request, which iirc was around 5%. My brother is very unwell with his diabetes and it’s scared me so for the last 5 years I’ve done one fasting and one post meal finger prick on the first day of every month - never an issue - small monthly variations but no discernible upward trend.

Five weeks ago I had a completely uncharacteristic high carb breakfast of porridge and honey (I know, what was I thinking), and then even more stupidly went to my 65 year well person appt. Random BG of 8.8 about 45 minutes after the porridge. So I monitor it at home for three weeks, 8 times a day. Highest reading I get is 5.8, mean is 4.4 and FBG usually low fours, high threes. When I go back to see the nurse she tests my wee and of course it’s full of ketones. As I would expect as I also do intermittent fasting. I don’t do keto as I eat a lot of veg but my diet is completely lacking (or deficient in her view) of starchy carbs and snacks. She instructs me that all I’m doing is eating to cheat the test, that I DO have diabetes, I’m just hiding it from myself and everyone else. I get handed the eatwell plate and told to eat three meals and two snacks a day (normally I eat two meals, zero snacks). I’ve had an uneasy relationship with food all my life and I’ve worked really hard to get to a place where food should be high quality fuel and not my security blanket.

I ignore this advice, carry on as normal and agree to an A1C to put the matter to bed. Which came back today at 5.1%. However, rather than settling things, it seems to have riled her even more and she insists that if I ‘persist in concealing my diabetes by refusing to follow standard medical advice’ then the only solution to open my eyes to the problem is to have a GTT. I’ve refused saying of course it will be high given my normal eating pattern, and I’m not prepared to make myself unwell for this test.

I just want to walk away now and get on with my life but she says I’m scared of the GTT because it will force me to face facts. I’m not stupid, I realise I have a family predisposition, I see how very unwell my younger brother is and I do want to be responsible. But I don’t want to do this test. Tell me honestly (I know you can’t diagnose me or tell me what to do, but I’d really value some insights) - am I bring irresponsible? Am I refusing to face facts here? Do I need to overhaul my diet (she also says that LC will have made insulin resistance so much worse that I will have done a lot of damage already). Im so upset and worried.

I think what you are doing is so right. You are listening to your body and what you need and want. What you are doing will lessen your insulin resistance over time. I would also refuse a GTT. Best of Luck and soldier on.

 

[AndBreathe]

I’ve posted a few times over the last few weeks and received excellent advice and support.

Long story short, I’ve been low carbing for 5 years since my brother was diagnosed T2. I did it to be his accountability buddy but he couldn’t stick with it. For me on the other hand, it really allowed me to come to peace with food and I felt so well I stuck with it. I had an A1C at that time at my request, which iirc was around 5%. My brother is very unwell with his diabetes and it’s scared me so for the last 5 years I’ve done one fasting and one post meal finger prick on the first day of every month - never an issue - small monthly variations but no discernible upward trend.

Five weeks ago I had a completely uncharacteristic high carb breakfast of porridge and honey (I know, what was I thinking), and then even more stupidly went to my 65 year well person appt. Random BG of 8.8 about 45 minutes after the porridge. So I monitor it at home for three weeks, 8 times a day. Highest reading I get is 5.8, mean is 4.4 and FBG usually low fours, high threes. When I go back to see the nurse she tests my wee and of course it’s full of ketones. As I would expect as I also do intermittent fasting. I don’t do keto as I eat a lot of veg but my diet is completely lacking (or deficient in her view) of starchy carbs and snacks. She instructs me that all I’m doing is eating to cheat the test, that I DO have diabetes, I’m just hiding it from myself and everyone else. I get handed the eatwell plate and told to eat three meals and two snacks a day (normally I eat two meals, zero snacks). I’ve had an uneasy relationship with food all my life and I’ve worked really hard to get to a place where food should be high quality fuel and not my security blanket.

I ignore this advice, carry on as normal and agree to an A1C to put the matter to bed. Which came back today at 5.1%. However, rather than settling things, it seems to have riled her even more and she insists that if I ‘persist in concealing my diabetes by refusing to follow standard medical advice’ then the only solution to open my eyes to the problem is to have a GTT. I’ve refused saying of course it will be high given my normal eating pattern, and I’m not prepared to make myself unwell for this test.

I just want to walk away now and get on with my life but she says I’m scared of the GTT because it will force me to face facts. I’m not stupid, I realise I have a family predisposition, I see how very unwell my younger brother is and I do want to be responsible. But I don’t want to do this test. Tell me honestly (I know you can’t diagnose me or tell me what to do, but I’d really value some insights) - am I bring irresponsible? Am I refusing to face facts here? Do I need to overhaul my diet (she also says that LC will have made insulin resistance so much worse that I will have done a lot of damage already). Im so upset and worried.

Bottom line is for any test, procedure or treatment our consent must be given. Simply do not consent to the test, if you don't want to have it. Provided you have capacity to make decisions the nurse must accept your decisions. irrespective of whether she agrees or not.

It's all about choices. You choose to eat a diet that suits you, and from which you seem to be thriving. In my view, your nurse's rationale is questionable, at best.

Even if you did happen to have diabetes, would she be giving you a hard time for controlling it? (Rhetorical)

 

[catinahat]

seems to have riled her even more and she insists that if I ‘persist in concealing my diabetes by refusing to follow standard medical advice

How can you be concealing diabetes? By her reasoning I must be concealing any number of ailments by refusing to smoke.
I don't understand what she is trying to achieve. Let's just say she's right and if you introduce more carbs into your diet you would become diabetic. How would you fix that? - - - oh I know, you could try a low carb diet!
She's as mad as a bag of frogs, ignore her.

 

[WelshSailor]

‘Mad as a bag of frogs’ - haven’t heard that saying before, it did make me laugh and I now have an image of her as an enraged frog (which is helping!)

So IF I did have diabetes - never diagnosed because of my dietary control - will it do me any harm not to ‘know’ it? When I’m already painfully aware of the risks and do everything in my power to identify early? She said I should be having special eye tests and nerve tests which I couldn’t have because I was dodging the facts. I suppose I’m asking will damage still be happening even with consistently normal BG, self-monitored every month? Written down, I feel bonkers for even asking these questions but she has made me feel I’m on the way to ruin. I’m embarrassed to be asking all this when I know how many people really are suffering, and I’m well - absolutely fine. Just scared witless by some random nurse who wants to shove pasta down my throat very day to manage my already well managed BG.

 

[Lamont D]

I don't want to be devils advocate here, however, I can think of one reason why she might want to use a OGTT.
If it is a two hours test, then they want to look at the initial first phase response to glucose. If you have insulin resistance, your insulin response may not be enough and the large spike you have seen is because of that.

A clever answer to your 'mad as a box of frog's dsn is to ask, a fasting OGTT or an extended five hour OGTT?s

however again!
Non diabetics do get high spikes, with normal hba1c.

But it always your decision.

Best wishes

 

[Lainie71]

I think what you are doing is so right. You are listening to your body and what you need and want. What you are doing will lessen your insulin resistance over time. I would also refuse a GTT. Best of Luck and soldier on.

Whats a GTT ?

 

[WelshSailor]

Gluc

Whats a GTT ?

Glucose tolerance test. From what she said you fast, have a sugary drink, and have your blood drawn at intervals for two hours.

 

[AndBreathe]

I don't want to be devils advocate here, however, I can think of one reason why she might want to use a OGTT.
If it is a two hours test, then they want to look at the initial first phase response to glucose. If you have insulin resistance, your insulin response may not be enough and the large spike you have seen is because of that.

A clever answer to your 'mad as a box of frog's dsn is to ask, a fasting OGTT or an extended five hour OGTT?s

however again!
Non diabetics do get high spikes, with normal hba1c.

But it always your decision.

Best wishes

I may be being extremely unkind, but I doubt the nurse understands about first and second phase insulin responses are. Few "diabetes nurses" in primary care have any specialist knowledge. More likely they are a practice nurse or HCA lumbered with diabetes clinics.

@WelshSailor those diagnosed with diabetes (even those in long term remission recieve eye screening, but in reality diabetic eye disease is generally associated with high or erratic blood glucose and/or blood pressure.

As for nerve tests? I've had my feet checked once since, around 2014, following my diagnosis in 2013, so that's all very hit and miss anyway.

 

[HSSS]

Agree with and echo everything above.

I’d also add why does she think you are diabetic (and hiding it)? The 8.8 an hour after the porridge? What the **ll does she think anyones would be at that time? And quite frankly most diabetics would be higher than that.

She also seems unaware of NICE guidance which states diagnosis is either fasted (8hrs min) over 7mmol and you were not fasted or random over 11.1mmol which is what should be applied in your case https://cks.nice.org.uk/topics/diabetes-type-2/diagnosis/diagnosis-in-adults/ .

There was also guidance (replaced 7 yrs ago by https://www.nice.org.uk/guidance/ng28 but referenced in the next link) that says under 8.5mmol at least 90mins after eating https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html and you were only 45 mins post meal. If you have to deal with this woman again take printouts of these to educate her maybe. Without doubt if you had waited the required extra 45 mins then you would have been below this.

Also non symptomatic diagnosis should have two “failed” readings. You’ve had one test very slightly high but not taken properly and a very much not diabetic hba1c. Next time you choose to test at the drs I’d go fasted or more than 2hrs after eating and you’d pass that with flying colours too. Does she grill everyone that passes an hba1c why they did or how they eat just in case they too are cheating?

As for an OGTT you would possibly fail as a result of your current way of eating. Not because you are harming yourself simply because your body is accustomed to having little glucose and demanding little insulin. If you simply jump off piste then you will probably go high (remember the porridge?). Anyone low carb is advised to “carb up” for a few days first to wake up the body to carbs again. It might be interesting for you to read about physiological insulin resistance aka adaptive glucose sparing which explains this and the fact it is quite different to pathological insulin resistance the nurse is panicking about.

It very much sounds like she’s anti as well as ignorant of low carb. What does she want? To diagnose you and then do what? Go on the eatwell diet and get worse needing more and more drugs? She’s dangerous and a bully. To the point I’d even consider a complaint especially if she’s marked your notes with inappropriate comments and I’d be asking for a full copy that covers the relevant time period to check.

As far as eye tests go you can get a similar sort of retinal scan at specsavers (other opticians available). Not one being assessed by diabetes specialists perhaps but whilst your levels are so good I see no reason why your risk is any higher than any other non diabetic persons. The foot test is a fibre optic fibre used to tickle your feet and check you can feel it. Do you have someone that could mimic that for you?

 

[Lamont D]

I may be being extremely unkind, but I doubt the nurse understands about first and second phase insulin responses are. Few "diabetes nurses" in primary care have any specialist knowledge. More likely they are a practice nurse or HCA lumbered with diabetes clinics.

@WelshSailor those diagnosed with diabetes (even those in long term remission recieve eye screening, but in reality diabetic eye disease is generally associated with high or erratic blood glucose and/or blood pressure.

As for nerve tests? I've had my feet checked once since, around 2014, following my diagnosis in 2013, so that's all very hit and miss anyway.

What I was trying to do, was give the OP, a line to ask the dsn what her understanding of an OGTT actually is used for. And I agree with you unless it has come up in training. You never know! I informed mine about it. My dsn was very curious!

 

[Antje77]

So IF I did have diabetes - never diagnosed because of my dietary control - will it do me any harm not to ‘know’ it?

Very unlikely.
Both the having diabetes, considering your hba1c, your numbers when testing and especially your <hour postprandial number of 8.8 after porridge, all the more because you were on a low carb diet at the time.
And also the doing harm. I have no idea how completely normal test results can do you harm.

How can you be concealing diabetes? By her reasoning I must be concealing any number of ailments by refusing to smoke.

From now on I'm going to refer to my treatment as concealing diabetes!
Nothing in my labs shows diabetes so I must be concealing it with all this insulin I inject. Naughty me!

 

[WelshSailor]

Thanks so much everyone, as always you’ve all been really informative and very reassuring, and thank you HSSS for these links, which I will definitely read in the morning. I really appreciate everyone’s help, I’ve become so stressed about all this. I think she is convinced I MUST have T2, as I have a younger sibling who has had it for 5 years plus that random test (which I’m still kicking myself about for my stupidity. Not so much for the sudden uncharacteristic notion for breakfast which as a one off would have passed unnoticed but rather for having the test so soon after. I just didn’t think but I won’t make that mistake again). So having convinced herself I have it, she thinks it’s just a case of seeking it out to ‘save’ me in some way. She is clearly an eatwell advocate and thinks no one can survive without a steady stream of carbs, topped up with the odd banana or energy bar between meals. As I said upthread I do eat far too many vegetables to be keto but as soon as she heard ‘low carb’ she translated it to ‘Atkins’ and insisted on telling me about the state the poor man was allegedly in when he died. No matter how much I tried to explain what I WAS eating all she could see was the lack of starch based carbs and a recommendation to replace my olive oil with 1 cal spray light because ‘olive oil is full of empty calories’. Plus of course she was annoyed by my testing which ‘isn’t recommended for T2s’. The entire thing has been a surreal and distressing experience and it given me some insight into what it must be like trying to negotiate a diagnosis without proper support. I’m so glad I found this forum straight after I first spoke to her or I don’t know what I’d have done.

 

[Robbity]

‘Mad as a bag of frogs’ - haven’t heard that saying before, it did make me laugh and I now have an image of her as an enraged frog (which is helping!)

I don't know about an "enraged frog", I think she's more of a deranged one myself....

And if you're hiding your diabetes because of your low carb diet, why I wonder was it not diagnosed prior to you starting to eat this way?

 

[EllieM]

Sorry if I'm late to the party (and I appreciate I'm a T1 cross posting to someone who is at genetic risk of T2) but I thought that diabetic complications (damage to eyes, nerves etc) were caused by high blood sugars. Indeed, my understanding of the reason that the diabetes diagnosis hba1c is set at 48mmol/mol or 6.5% is because that was the level below which there was very little retinopathy.

So if you are avoiding higher bgs by avoiding carbs I can't see why the NHS would want or need to waste resources on testing for complications that you aren't at risk of getting.

And my understanding of GTTs is that you have to "carb up" for several days before to get a valid result, so why on earth would you want to do that?

 

[finzi1966]

Your nurse is profoundly ignorant. You don’t “hide” high blood sugars by eating low carb - you just don’t get them in the first place! And if you don’t have them, then you don’t have diabetes complications. There’s not some evil “diabetes fairy” that gives you dodgy feet, eyes and kidneys. Persistently raised blood sugars do that.

A BG of 8.8 shortly after eating porridge with honey is completely normal for a non-diabetic which is what you are.

Now whether you’d be at risk later in life of type 2 diabetes if you persistently ate a high carb diet…well maybe. Who knows? Certainly not the nurse.

 

[Lainie71]

Gluc

Glucose tolerance test. From what she said you fast, have a sugary drink, and have your blood drawn at intervals for two hours.

Thanks it all becomes clear now

 

[bulkbiker]

on telling me about the state the poor man was allegedly in when he died.

He fell on the ice cracked his head and died from a brain aneurism..

I'd love to see her blame his diet for that one!