Glucose Tolerance Test Results

[YMF12]

Hi I’ve been following this forum for a while as it was thought I might be suffering with RH but having just had the results by letter today the endocrinologist has discharged me saying I don’t and that’s it. This has left me wondering where I go from here?

I’m not a diabetic and my fasting glucose is generally around 5.0. Before last summer I was healthy but then one night I woke up shaking uncontrollably and sweating and feeling dreadful. This happened a few more times, always around two to three hours after dinner. I did speak with my GP but he thought it might be a panic attack, I’ve never had those before and didn’t think it was. Anyway a friend suggested I check my glucose and I found when I was shaky it it was around 4.0. Next time I had an attack I took glucose and the shaking stopped.

I waited some time for a referral to the Endocrinologist and in the meantime started to investigate what caused spikes. I have been eating low carb for months now and generally avoid hypos, two days after the glucose tolerance test I had what felt like a bad hypo attack. It was three hours after dinner but when I measured my glucose it was 5.0. I hadn’t had a high carb meal but did have 2 glasses of wine which is more than I normally have. Because things didn’t settle down I did take some glucose and the shaking etc calmed down. Are these false hypos or is it the wine?

The endocrinologist did numerous tests and said they were all within range. The only things out of range is my gamma gt and ferritin levels which are both high.

These are the glucose levels recorded by the hospital during my 5 hour GTT. I also took some reading of my own using my own glucometer and I’ve added those as well.
Hospital Readings
9.30 - 5.5 mmol/L Drank the glucose at 9.35 yuk! 10.30 - 8.6 11.30 - 5.4 12.30 - 4.4 13.30- 3.6 14.30 - 4.1

My Tee2 readings
10.37. 9.3
11.38. 6.9
12.13. 7.9
12.53. 5.4
13.40. 4.2
14.10. 4.1
14.39. 4.1

I’m not sure where to go from here shall I just assume it’s just one of those things and just carry on with low carb and put up with the occasional what feels like a a very horrible scary hypo or should I be asking more questions.? Any comments and advice very welcome. Apologies for the long post.
Yvonne

 

[Brunneria]

Hi and welcome,

Please remember that I am not a healthcare professional, and I am not medically qualified.
However, I would not rule out RH on the basis of your results.
The tests were taken an hour apart.
You could easily have dipped into hypo territory on the hour gaps.
Did you have any hypo symptoms.

I am afraid this highlights the problems inherent in non-continuous glucose monitoring.

The reality is that if you had received an RH diagnosis, you would most likely have been told to go away and eat carbs every 3 hours for the rest of your life. Not a fate I would wish on any RH sufferer!

if, as you say, you have been eating low carb and mainly avoiding hypos, then that is a path I would continue to follow - armed with your trusty blood glucose meter, and hopefully keeping those hypos at bay.

 

[Lamont D]

Hi I’ve been following this forum for a while as it was thought I might be suffering with RH but having just had the results by letter today the endocrinologist has discharged me saying I don’t and that’s it. This has left me wondering where I go from here?

I’m not a diabetic and my fasting glucose is generally around 5.0. Before last summer I was healthy but then one night I woke up shaking uncontrollably and sweating and feeling dreadful. This happened a few more times, always around two to three hours after dinner. I did speak with my GP but he thought it might be a panic attack, I’ve never had those before and didn’t think it was. Anyway a friend suggested I check my glucose and I found when I was shaky it it was around 4.0. Next time I had an attack I took glucose and the shaking stopped.

I waited some time for a referral to the Endocrinologist and in the meantime started to investigate what caused spikes. I have been eating low carb for months now and generally avoid hypos, two days after the glucose tolerance test I had what felt like a bad hypo attack. It was three hours after dinner but when I measured my glucose it was 5.0. I hadn’t had a high carb meal but did have 2 glasses of wine which is more than I normally have. Because things didn’t settle down I did take some glucose and the shaking etc calmed down. Are these false hypos or is it the wine?

The endocrinologist did numerous tests and said they were all within range. The only things out of range is my gamma gt and ferritin levels which are both high.

These are the glucose levels recorded by the hospital during my 5 hour GTT. I also took some reading of my own using my own glucometer and I’ve added those as well.
Hospital Readings
9.30 - 5.5 mmol/L Drank the glucose at 9.35 yuk! 10.30 - 8.6 11.30 - 5.4 12.30 - 4.4 13.30- 3.6 14.30 - 4.1

My Tee2 readings
10.37. 9.3
11.38. 6.9
12.13. 7.9
12.53. 5.4
13.40. 4.2
14.10. 4.1
14.39. 4.1

I’m not sure where to go from here shall I just assume it’s just one of those things and just carry on with low carb and put up with the occasional what feels like a a very horrible scary hypo or should I be asking more questions.? Any comments and advice very welcome. Apologies for the long post.
Yvonne

I agree with @Brunneria, unfortunately without continuous glucose monitoring, the readings between those done is unknown.
Can't understand why they didn't do glucose readings at least every half hour, or even fifteen minutes firstly to find the spike, to see how your initial insulin response is, to keep you from dropping quickly if you have what is known as glucose dumping!
And finally to see if at the point at which you do go hypo if you do! That is what is eOGTT is for! How can you get a true diagnosis of which type of hypoglycaemia if you don't get a comprehensive test?
However, because of the results that you have given us, they are not typical RH results.
You could always, keep a food diary and continue checking your own blood glucose levels after food, this will help you and your GP give an idea what is going on.
If low carb works, then why not keep doing it!

Keep safe

 

[YMF12]

Thanks for your replies. I was surprised that they didn’t take more readings as well. I asked how it was going to work and when they said they would just take readings every hour I asked how would they be monitoring I wasn’t going hypo they said tell us if you feel unwell and we’ll take some more blood and send it down to the lab and if they confirm you are hypo we’ll give you a sandwich or something! I had assumed they would take very frequent readings using a glucometer as well as the lab bloods but no.
Toward the last hour I was feeling a bit shaky but no hypo as such. I did notice on my own readings that they started to go down and then went up again so a small double spike.

I’ve been doing low carb on and off for many years for weight loss not because I had any glucose issues just to lose weight. In the last two years I followed a more strict low carb regime but was still able to switch to more carbs with no issues for special occasions etc. My hypo issues started last Summer, do you think there is any possibility that you can sensitise your system to carbs by restricting them for months then suddenly eating them again? A bit like not having any alcohol for ages then having one drink and it going straight to your head.

I was debating trying to contact the Endocrinologist next week to ask if we could talk over my results but now from your feedback wondering if there is any point. She did mention a special diet of lots of small meals and that really wouldn’t suit me. I’ve been working on my food tolerances for some time now and have in general worked out what can cause the larger spikes. I generally eat two meals a day, approx 13.00 and again 20.30. I do sometimes need a snack around 5pm as I can get quite low especially if I have been quite active.

If I could just work out what still gives me the occasional hypo that would be great.

 

[Lamont D]

Thanks for your replies. I was surprised that they didn’t take more readings as well. I asked how it was going to work and when they said they would just take readings every hour I asked how would they be monitoring I wasn’t going hypo they said tell us if you feel unwell and we’ll take some more blood and send it down to the lab and if they confirm you are hypo we’ll give you a sandwich or something! I had assumed they would take very frequent readings using a glucometer as well as the lab bloods but no.
Toward the last hour I was feeling a bit shaky but no hypo as such. I did notice on my own readings that they started to go down and then went up again so a small double spike.

I’ve been doing low carb on and off for many years for weight loss not because I had any glucose issues just to lose weight. In the last two years I followed a more strict low carb regime but was still able to switch to more carbs with no issues for special occasions etc. My hypo issues started last Summer, do you think there is any possibility that you can sensitise your system to carbs by restricting them for months then suddenly eating them again? A bit like not having any alcohol for ages then having one drink and it going straight to your head.

I was debating trying to contact the Endocrinologist next week to ask if we could talk over my results but now from your feedback wondering if there is any point. She did mention a special diet of lots of small meals and that really wouldn’t suit me. I’ve been working on my food tolerances for some time now and have in general worked out what can cause the larger spikes. I generally eat two meals a day, approx 13.00 and again 20.30. I do sometimes need a snack around 5pm as I can get quite low especially if I have been quite active.

If I could just work out what still gives me the occasional hypo that would be great.

Yes, a typical double spike!
The big question is, have you ever recorded a hypo? My endocrinologist would specify a hypo as being below 3.5mmols going further down below 3.00mmols.
This is why a food diary is a great way to get information. Just imagine all that trial and error with your food intolerance, recorded for your doctors to look at!

What you have described eloquently about the beer effect is called hypo awareness.
You can actually feel yourself coming out of normal levels or a quick drop similar to a false hypo.
Don't beat yourself up too much about having a regular eating time slot because sometimes you just can't keep to it for so many reasons. The most common is having a cold, blood glucose levels are always a little bit higher than your usual when you are ill.
There is always a good chance in the future that because of your symptoms, something can change and you will be able to get a better chance of getting the right tests. So I wouldn't rule out asking for more clarity, ask about other hypoglycaemic types such as glucose dumping or post prandial syndrome.

Keep asking

Keep safe