Failed GTT & Circumstances

Triceraptors · Dec 1, 2017

Sorry for the long wall of text guys but I need next steps. I am 24, thin and male.

6 days ago, I started feeling sweet taste in my mouth. This happened in the past before when not eating enough and my body started to run on ketones 1.5 years ago. 2-3 days before this, I barely ate food. And even then, mostly nuts and lots of tea (no sugar). Soon after sweet taste, headaches started, stomach was hurting weirdly and was dizzy as hell. This happened after eating a large sweet cake having not eaten much for the past 2-3 days and barely any carbs.

Went to emergency room, who tested my blood glucose at 5.2 and lots of ketones in urine. I was running on very little calories, maybe 500 a day, mostly from protein and fats. I continued this, feeling worse and worse at work until Wednesday when I could not take it anymore and had to leave. Still was not eating much since Saturday and drinking lot of tea and eating nuts. Scared, went to GP, he sent me straight to blood tests on Thursday and I had to undergo GTT a day after, today. I was still not drinking enough water or eating much calories at all and went to GTT while starving and having not eaten any carbs for 3-4 days. 2 days before GTT, I noticed my urine was: smelling sweet, was dark. Doctors told me there is a trace of blood in the samples. The sweet smell was 4+ ketones. The darkness was actually dehydration AND blood.

During GTT, my kidneys started to hurt after an hour. The pee became even darker and I had to quit the test and run straight to emergency room again ... I forced them to check my blood sugar at around 2 hours mark since GTT start and it was 13.8 :\\\ My blood pressure was 156/78. They took urine samples, Contained visible blood and ketones. No glucose. In addition, markers of infection in urine. I am referred to urologist for tomorrow by the hospital.

However, I am very concerned with me failing GTT so horribly. Would starvation and dehydration + almost zero carbs for a few days before would be the reason my glucose spiked so much? I have some tests results for glucose. Usually, fasting glucose is 4.4-4.6. It was the same on the test yesterday. However, Hba1c tells a different story in my opinion. It was 4.6 in 2015, 4.8 in 2017 June and now 4.9 on yesterday test.

This seems to indicate lower glucose tolerance and it seems to be getting worse. Would dumping 100g of glucose into starving and dehydrated body cause the glucose to stay at 13.8 after 2 hours? Seems very unlikely, and bothers me greatly. I decided to run a low carb diet since today, until I can get more answers.

Would it be wise to ask for tests for type 1 diabetes from my GP? He sounded concerend with blood glucose so high after 2 hours.

ringi · Dec 1, 2017

I think the dehydration is the primary issue you need to sort out....... (You may need to take some salt as well as water.)

lucylocket61 · Dec 1, 2017

why are you eating and drinking so little? Of course, its going to make you unwell. Especially not drinking enough.

Triceraptors · Dec 1, 2017

I have a habit of calorie restriction and forget hydration when very worried and sick :\

Could someone comment on what the hell happened during GTT and what are the wise steps to take when I meet the doctor next time?

paulus1 · Dec 1, 2017

have you been refereed to a eating disorder clinic. unless there is a serious reason for such a crash diet your hurting yourself for no purpose.. there really is no need to be that low. at that level your body will be using its fats and proteins to try and keep you alive. this will eventually fail. there is a vast difference between that and a proper lchf diet.

im sorry but its not always easy to cope with things. but hurting yourself to compensate is only going to make things worse. the body grabbed the glucose and sent it out to your starving body. your not diabetic but your are hurting yourself.

Lamont D · Dec 1, 2017

Was the OGTT a two hour or extended OGTT?
What was your readings before the two hour mark, because they should have taken reading at every half hour?

The concern about the high in the context you have described is because at the (standard) two hour mark, your readings in most normal people, should be lower than that.
But I could not even guess as to what is happening to you.
The dehydration will effect the test, if it is a two hour test, you not eating normally and having ketones etc, will let you fail the test.
The urinary infection will skew the results as well.

Did the hospital not give you details what you should have done before the test?
If not, that is shocking!

I would advise to eat and drink as you usually do until you get an inkling of a diagnosis.

Best wishes

Mbaker · Dec 1, 2017

It seems you are on an extraordinarily low calorie regime, I couldn't see anything in your profile to indicate why. I eat what you do i.e. nuts and tea, but I also have full nourishing meals alongside this. 500 calories of nuts alone is perhaps a cup full. Would you consider drinking more water, adding additional food groups, maybe some fruit, veg and protein, then having your full bloods drawn by your surgery, just to check all is in order.

If you are struggling, your health care professional will be more than happy to support you get the balance right.

catapillar · Dec 1, 2017

Triceraptors said:
I was still not drinking enough water or eating much calories at all and went to GTT while starving and having not eaten any carbs for 3-4 days. 2 days before GTT, I noticed my urine was: smelling sweet, was dark. Doctors told me there is a trace of blood in the samples. The sweet smell was 4+ ketones.

Anyone not eating carbs, or not eating, will have ketones. If you aren't eating, your body will be burning your body fat for fuel and this will produce ketone. These are called starvation ketones. If you aren't eating carbs then your body will turn the fat you eat into fuel and this produces ketones. These are called nutritional ketones. If you aren't diabetic (which you aren't) and you don't have high blood sugar (which you don't) these ketones come from normal body processes and aren't anything to worry about. Although they should be taken as a fairly strong indication that you just need to eat a sandwich.

Triceraptors said:
However, I am very concerned with me failing GTT so horribly. Would starvation and dehydration + almost zero carbs for a few days before would be the reason my glucose spiked so much?

Yes. Anyone on a low carb diet is likely to fail a GTT and get a false positive. Prior to undertaking a GTT you are advised to have a normal carb diet for at least 5 days. Otherwise, your body gets out of practice a dealing with carbs and doesn't know what to do with the sudden shock of carbs in the GTT.

Triceraptors said:
Hba1c tells a different story in my opinion. It was 4.6 in 2015, 4.8 in 2017 June and now 4.9 on yesterday test.

No it doesn't. A hba1c of 4.9% is normal. It equates to an average blood sugar level over the last three months of 5.2 mmol/l. Which is perfectly normal and non diabetic.

Triceraptors said:
Would it be wise to ask for tests for type 1 diabetes from my GP? He sounded concerend with blood glucose so high after 2 hours.

There is no indication whatsoever that you have type 1 diabetes. An undiagnosed type 1 doing a GTT is likely to end up with blood sugars over 30. An undiagnosed type 1 will not have a non diabetic hba1c.

You feel sick because you have a UTI.

You seem to be rather fixated on having diabetes, that you don't have. You posted 1 year and 34 weeks ago - http://www.diabetes.co.uk/forum/thr...ptoms-doctor-reassurance-does-not-help.98971/ - to say you had type 1 with a very similar story and yet, you didn't have diabetes. If you would like some diabetes, you are more than welcome to have mine.

Bluetit1802 · Dec 1, 2017

Triceraptors said:
However, I am very concerned with me failing GTT so horribly. Would starvation and dehydration + almost zero carbs for a few days before would be the reason my glucose spiked so much?

The simple answer to this is ... yes.

The instructions for the OGTT issued to doctors is that the patient should be advised to eat 150g of carbs for 3 days beforehand. Failing to do this could result in a failed test.

Many doctors now use a substance called Rapilose for these tests as it is a pre-prepared drink of exactly 75g of glucose and nothing else. These are the instructions issued with it

1. Patient Preparation The test should only be carried out on patients who are on a stable diet, at a constant weight and with no acute illness. The patient should have maintained an adequate carbohydrate intake (125- 150g/day) for three days prior to the scheduled OGTT. The patient is required to fast overnight before the test for a minimum nine hours with nothing by mouth except water (no medications, caffeine or tobacco).

Other factors can weaken the diagnostic power of the test and should be avoided as far as possible. These include severe inactivity over the preceding weeks, bed rest for several days, medical or surgical stress, fear of venepuncture, smoking during the test and certain drugs including thiazides, ß-blockers, glucocorticoids and phenytoin.

http://penlanhealthcare.com/uploads/Rapilose-OGTT-Instructions-For-Use.pdf

You do not appear to have been a suitable person for this test at the time it was taken.

Resurgam · Dec 1, 2017

I'm concerned that you have some form of anorexia or another eating disorder to be doing such strange things to yourself.
Please tell your doctor what you are doing to yourself and see if you can get some help before you go too far and have permanent damage.

Bluey1 · Dec 2, 2017

Mate, why don't you join us as an honorary D. We need you at our virtual parties, while we are eyeing off that great big delicious slice of chocolate cake, we need you to eat it for us and let us fight over the next biggest slice. I'm pretty certain your Dr has spoken to you about your food intake? My aim today is to go under 80g of carbs how about your goal is to go over 80g of carbs unless your Dr has told you not to.

Triceraptors · Dec 2, 2017

Bluetit1802 said:
The simple answer to this is ... yes.

The instructions for the OGTT issued to doctors is that the patient should be advised to eat 150g of carbs for 3 days beforehand. Failing to do this could result in a failed test.

Many doctors now use a substance called Rapilose for these tests as it is a pre-prepared drink of exactly 75g of glucose and nothing else. These are the instructions issued with it

1. Patient Preparation The test should only be carried out on patients who are on a stable diet, at a constant weight and with no acute illness. The patient should have maintained an adequate carbohydrate intake (125- 150g/day) for three days prior to the scheduled OGTT. The patient is required to fast overnight before the test for a minimum nine hours with nothing by mouth except water (no medications, caffeine or tobacco).

Other factors can weaken the diagnostic power of the test and should be avoided as far as possible. These include severe inactivity over the preceding weeks, bed rest for several days, medical or surgical stress, fear of venepuncture, smoking during the test and certain drugs including thiazides, ß-blockers, glucocorticoids and phenytoin.

http://penlanhealthcare.com/uploads/Rapilose-OGTT-Instructions-For-Use.pdf

You do not appear to have been a suitable person for this test at the time it was taken.

I told my doctor about me having no appetite and being dehydrated with almost zero carbs and he said it is all fine and that does not affect test results.

Here is my concern. It seems that I am headed towards something wrong with glucose metabolism because:

1. I am feeling less energetic since September. I do not do any exercise besides walking in the office and do not sleep that well. However, my sleep was really bad for years. I did a sleep study and had no answers from that except 5% REM sleep is abnormal and I randomly wake up from deeper sleep stages very often during the night.

2. I was eating a lot of **** for the past 3-4 months. Doritos in the evening instead of a proper meal. Rice, meat vegetables almost every day. Very sweet fruit cakes and white bread, etc. I am cutting out my carbs intake significantly because this is just wrong.

3. My test results for blood glucose seem to be increasing. In 2015, fasting was 4.4, Hba1c was 4.6 and even with frequent going to the gym and having a lot more muscle mass, my creatinine was 80. Now, in 2017 June, HBa1c is 4.8, fasting glucose 4.6 and creatinine without going to the gym is still 80. It is known that this parameter is higher in people who have more muscle mass. Finally, 4.9 Hba1c just recently. However, during this starvation, my fasting glucose was 3.9 LOL.

catapillar said:
Anyone not eating carbs, or not eating, will have ketones. If you aren't eating, your body will be burning your body fat for fuel and this will produce ketone. These are called starvation ketones. If you aren't eating carbs then your body will turn the fat you eat into fuel and this produces ketones. These are called nutritional ketones. If you aren't diabetic (which you aren't) and you don't have high blood sugar (which you don't) these ketones come from normal body processes and aren't anything to worry about. Although they should be taken as a fairly strong indication that you just need to eat a sandwich.

Yes. Anyone on a low carb diet is likely to fail a GTT and get a false positive. Prior to undertaking a GTT you are advised to have a normal carb diet for at least 5 days. Otherwise, your body gets out of practice a dealing with carbs and doesn't know what to do with the sudden shock of carbs in the GTT.

No it doesn't. A hba1c of 4.9% is normal. It equates to an average blood sugar level over the last three months of 5.2 mmol/l. Which is perfectly normal and non diabetic.

There is no indication whatsoever that you have type 1 diabetes. An undiagnosed type 1 doing a GTT is likely to end up with blood sugars over 30. An undiagnosed type 1 will not have a non diabetic hba1c.

You feel sick because you have a UTI.

You seem to be rather fixated on having diabetes, that you don't have. You posted 1 year and 34 weeks ago - http://www.diabetes.co.uk/forum/thr...ptoms-doctor-reassurance-does-not-help.98971/ - to say you had type 1 with a very similar story and yet, you didn't have diabetes. If you would like some diabetes, you are more than welcome to have mine.

Isn't type 1 a sudden onset one? I did post that long time ago because I had similar symptoms and was concerned. After symptoms disappeared, I did not think about it anymore and ate normally. Looking back until now, it seems like I get sluggish and some brain fog after eating carbohydrate-rich meals. However, this is true for quite a few years and am not sure if it is connected.

I am still thinking of cutting out most crapy carbs, eat more protein and fat from now on. And get the GP to do more tests because all of this, especially GTT result, is clearly abnormal. I like my kidneys, and bleeding due to likely kidney stones and high glucose connection is making me scared.

catapillar · Dec 2, 2017

Triceraptors said:
I am still thinking of cutting out most crapy carbs, eat more protein and fat from now on. And get the GP to do more tests because all of this, especially GTT result, is clearly abnormal. I like my kidneys, and bleeding due to likely kidney stones and high glucose connection is making me scared.

There is literally no point repeating a GTT while on a low carb diet, as this will result in false positives. People following a low carb diet are advised to have a normal carb intake for around a week in preparation for a GTT.

Yes, type 1 is sudden onset. You don't have it.

You don't have high glucose.

You do have a UTI. Kidney pain/ blood in the urine suggests the infection in your urinary tract has probably crept a bit higher and you have a kidney infection, you just need some antibiotics, and a proper meal. Dehydration is likely to be exacerbating any UTI symptoms, so you need to drink some water too.

Triceraptors · Dec 2, 2017

catapillar said:
There is literally no point repeating a GTT while on a low carb diet, as this will result in false positives. People following a low carb diet are advised to have a normal carb intake for around a week in preparation for a GTT.

Yes, type 1 is sudden onset. You don't have it.

You don't have high glucose.

You do have a UTI. Kidney pain/ blood in the urine suggests the infection in your urinary tract has probably crept a bit higher and you have a kidney infection, you just need some antibiotics, and a proper meal. Dehydration is likely to be exacerbating any UTI symptoms, so you need to drink some water too.

To add to my symptoms, I feel like **** right now after: eating 3 slices of mozarella, spicy chicken breast and 1 tomato. The head is heavy, some sweating and rapid heart beat, shivers. Almost zero carbs, but this meal had the following effect. I just cannot shake it off that I am unfortunately unable to process glucose. Any ideas what could be causing this?

Resurgam · Dec 2, 2017

As you had a very low carb meal why are you associating the feelings you are having with high glucose?
It reads more like a panic attack to me. Not that I am all that familiar with such things, nor a trained health carer - but I do read and observe far too keenly.

It could well be that you are suffering from dehydration, and perhaps you could not chew your food properly and so bolted it down. A dry mouth, insufficient water and eating quickly might mean the spices do not do you any favours.
I am a diabetic, but I can still eat up to 60 gm of carbs a day without elevating my blood glucose, but I drink water at regular intervals throughout the day, I eat slowly and calmly, and very little processed foods, particularly meat - the chicken breast was most likely, by my standards, highly processed - if it came in a packet look at what there was besides the chicken - presumably there was no skin on it, so it was not as nature intended.

catapillar · Dec 2, 2017

Triceraptors said:
To add to my symptoms, I feel like **** right now after: eating 3 slices of mozarella, spicy chicken breast and 1 tomato. The head is heavy, some sweating and rapid heart beat, shivers. Almost zero carbs, but this meal had the following effect. I just cannot shake it off that I am unfortunately unable to process glucose. Any ideas what could be causing this?

Your hypochondria? You obviously have fairly significant anxiety and this can cause physical symptoms. Your UTI? Obviously, if you have an infection, you'll be feeling under the weather.

It doesn't seem like the sweating, rapid heart beat and shivers are anything to do with glucose.

Triceraptors · Dec 2, 2017

Resurgam said:
As you had a very low carb meal why are you associating the feelings you are having with high glucose?
It reads more like a panic attack to me. Not that I am all that familiar with such things, nor a trained health carer - but I do read and observe far too keenly.

It could well be that you are suffering from dehydration, and perhaps you could not chew your food properly and so bolted it down. A dry mouth, insufficient water and eating quickly might mean the spices do not do you any favours.
I am a diabetic, but I can still eat up to 60 gm of carbs a day without elevating my blood glucose, but I drink water at regular intervals throughout the day, I eat slowly and calmly, and very little processed foods, particularly meat - the chicken breast was most likely, by my standards, highly processed - if it came in a packet look at what there was besides the chicken - presumably there was no skin on it, so it was not as nature intended.

catapillar said:
Your hypochondria? You obviously have fairly significant anxiety and this can cause physical symptoms. Your UTI? Obviously, if you have an infection, you'll be feeling under the weather.

It doesn't seem like the sweating, rapid heart beat and shivers are anything to do with glucose.

Because I felt exactly the same when after GTT and they measured excessive blood sugar value. God ****, I need to get a glucose meter and stop guessing what is happening to me. What about type 1 diabetes? Wouldn't even such a low carb meal would spike such person's blood sugar?

Resurgam · Dec 2, 2017

But you went to have the GTT after starving yourself for days - you really need to look after yourself in a more considered way, so that your body can deal with anything that is wrong - lack of water can be a very significant factor where kidneys are concerned.
If you make set times for drinking water through the day then it will be a good start, just a cup at a time about six or seven times during the day. When someone has high glucose that is the first thing suggested to lower it, so it would be a good thing to do.

lucylocket61 · Dec 2, 2017

Triceraptors said:
Because I felt exactly the same when after GTT and they measured excessive blood sugar value. God ****, I need to get a glucose meter and stop guessing what is happening to me. What about type 1 diabetes? Wouldn't even such a low carb meal would spike such person's blood sugar?

You did the GTT after low carbing for days. Therefore the result is irrelevant and wrong, due to this. So can, at this stage, be ignored. What does your doctor say about your shivering etc?

Triceraptors · Dec 2, 2017

Resurgam said:
But you went to have the GTT after starving yourself for days - you really need to look after yourself in a more considered way, so that your body can deal with anything that is wrong - lack of water can be a very significant factor where kidneys are concerned.
If you make set times for drinking water through the day then it will be a good start, just a cup at a time about six or seven times during the day. When someone has high glucose that is the first thing suggested to lower it, so it would be a good thing to do.

I went to urologist today and he told me it is from dehydration that the small stone formed and I pushed it out with bleeding. I am drinking a lot more water now.

How do people feel when they have high or low blood sugar?

lucylocket61 said:
You did the GTT after low carbing for days. Therefore the result is irrelevant and wrong, due to this. So can, at this stage, be ignored. What does your doctor say about your shivering etc?

I did not mention shivering to him yet because it is occasional. He also does not know I was not eating much or had very little carbs. I will tell him and then we can reconsider...

-----

I tried to recall the other issues I was having for years. For a few years, when exercising I was sweating horribly compared to other gym goers. No one else seemed so wasted after workouts and I attributed it to not doing cardio. I now live mostly sedentary life and cannot climb too flights of stairs without my heart beating noticeably. My extremities, feet and hands are now frequently cold. I had this problem for 3-4 years at least. I remember my father noticed how cold my feet are and told me what's up. I just shrugged it off. For years, after high carb meals I felt sluggish and wanted to go lay down a bit. I have more brain fog after eating a meal as well. I also think that I am losing too much hair.

--------

Just recently, started to feel huge growling in my stomach area, pressure in the stomach area and lots of saliva in the mouth out of nowhere. Is this a crazy hunger?

Feeling really weak and shaky, like fainting. Is it hypo? 2 hours after my meal, I had a headache and felt lethargic as hell.

Failed GTT & Circumstances

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