2.7 two hours after FGTT!! Yikes!

clearviews

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Recently my husband asked for a print out of all his BG test results which the doc happily gave him.
2006 his fasting level was 5.8 a month later he was sent for a FGTT. His fasting level was 5.5 then his reading 2 hours after the glucose drink was 3.4.
2009 his fasting level was 6.0 so he was sent for another FGTT. This time the fasting level was 5.5 and two hours later he was 2.7

His (new) dctor told him that he was just fine and that 2.7 was a nice low figure. I was astounded. I re-read my literature by Atkins and Bernstein. The indication is that he may well be classed as pre-diabetic (impaired). The other problem with the last test is he has been moderate low carbing for 4 months and I now understand that one should eat a full blown carb diet for 3 days prior to the FGTT.

The pathology report even helpfully printed an 'H' beside all his fasting BGL and a 'L' beside the 2 hours after results so their parameters do seem to concur with my reading.

His BMI was 30.1 then 29.5 and now 27.5 and he is 59 years old. Would the learned crew suggest that he gets a second opinion?
 

hanadr

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This doesn't seem like a clear cut case. I'd request a visit to a specialist.
Hana
 

clearviews

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Thanks hanardr

He will do just that. He has a T1 son and a coeliac daughter while his brother has a T1 daughter and a coeliac daughter. There is a strong genetic connection here but his stuff seems to be a mix of T2 happenings. Will report any findings
Alison
 

clearviews

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My husband has just been to another doctor and put his concerns about his fasting levels and FGTT results. The doctor was about the same age as him and told him his own fasting levels were about 5.7 and he wasn't worried so my H shouldn't. Said a specialist has only one recourse in this situation and that would be to put him on Metformin and his figures do not warrant that. He also said that his extemely low figures just proved that his system was well able to cope with a large influx of glucose.

Husband said that his mention of recent low carbing fell on deaf ears and the doc just didn't register that. He also said that the parameters had been revised and all was within normal range. That just doesn't make sense when his first fasting test was 4 years ago and way back then the pathology lab showed an "H" beside it and all subsequent results and noted that "high fasting levels had been noted in previous tests".

He is going to continue the low carb route he began 4 months ago as he has noted many other health benefits to him.
 

phoenix

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Hi I'm not an expert but I did a bit of looking up. This is what I found.
The fasting levels your OH has are under the cut off levels for impaired fasting glucose as defined by the World Health Organisation (6.1mmol). M.s Atkiins and Bernstein practice in the US where the ADA uses a lower level of 5.6mmol.
Because of this difference the WHO revisited it's advice in 2007 this is what they recommended
The fasting plasma glucose cut-point for Impaired Fasting Glucose (IFG)
should remain at 6.1mmol/l.
This decision was based on concerns about the significant increase in IFG
prevalence which would occur with lowering the cut-point and the impact
on individuals and health systems. There is a lack of evidence of any
benefit in terms of reducing adverse outcomes or progression to diabetes
and people identified by a lower cut-point eg 5.6mmol/l (100mg/dl) have
a more favourable cardiovascular risk profile and only half the risk of
developing diabetes compared with those above the current WHO cutpoint.
Lowering the cut-point would increase the proportion of people
with IGT who also have IFG but decreases the proportion of people with
IFG who also have IGT.
Consideration should be given to replacing this category of intermediate
hyperglycaemia by an overall risk assessment for diabetes, cardiovascular
disease, or both, which includes a measure of glucose as a continuous
variable.
The low level following the GTT shows that the insulin was at present sufficient and working well, perhaps rather too well. I did some looking up to find out what this very low level might signify and found that low levels can occasionally indicate other problems, so if there are other symptoms they should be investigated. However, I found a suggestion that the low carb diet may be responsible.
I'm not sure about how valid this particular source is (it's from the type of website I normally avoid)
but I found this
1) the gtt test used to be used to diagnose 'reactive' hypoglycaemia it the level fell below 50mg/dl (2,7mmol)
2) It wasn't a good test one reason was 'it was frequently performed improperly. 'Consider that unless a patient undergoing the procedure ate extra carbohydrates for three days prior to the test, blood sugar readings could come in abnormally low; a hefty dose of sugar following several days of a relatively low-carbohydrate diet can throw off the system. That caveat was often overlooked and led to over-diagnosis'.... http://www.encognitive.com/node/5445

further searching did show that people are told to eat a normal or often in the case of pregnant women a high carb diet before testing.

The one thing about his rising level of fasting glucose is that he is still at a level where lifestyle may prevent diabetes (exercise, weight loss, healthy diet.. I'll not define that!)
 

clearviews

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Thank you so much for your time.

He wasn't low carbing when he had the first OGTT 4 years ago and recorded a 3.4 after the two hours. I really think that the HPs really are not strongly into prevention of full blown diabetes so it is left to the individual to investigate and take action, or not.

He is happy to be a guinea pig to see if he can hold off the possibility of developing diabetes by carb reduction and I think that if he ever has to have a OGTT he will carb up for 3 days prior to see what that does. Meanwhile I (the T2 diabetic controlled by diet alone and exercise) am winning the fasting readings hands down over husband and when he was eating a "normal" carb level my after meal reading were way better too.
 

clearviews

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Oh and it seems that Australia also uses almost the same level as the USA for impaired 5.5+ as defined on the helpful range notation on his pathology report -fasting normal range 3.0-5.4. I also see that the pathology report also wrote "the previous abnormal glucose result is noted". That was the 6.0 he got in June 2009.
Thanks Pheonix again
Alison