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Insulin test

A

Adam01

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21
Been a bit of a lurker on this site for a while and was just after some advice. Firstly the background: my wife is 25, always been slim and fit. She has a bmi of 18.3. Used to have a pretty bad diet but could always 'get away with it' and never put on weight. She was diagnosed with gestational diabetes when she was 23. She managed to control it with diet by being very strict. However this didn't go away and doctors concluded that it wasn't true gestational diabetes, either something triggered during pregnancy or there before. Shes now managing on a low carb diet (roughly 50 - 80g per day). She's currently under an endocrinologist - had a recent GTT (which she did 'carb up' for) and, whilst her result doesn't make her officially diabetic (10.6), the endocrinologist wants to keep seeing her to keep an eye on things. He believes that she isn't insulin resistant but seems have some beta cell dysfunction. We're aware that being slim/young doesn't automatically discount type 2 but the consultant did say it could be another type of diabetes but testing could be expensive and we would need family history which is proving difficult to get. She doesn't have another appointment until January and we are really keen to get some answers as it's all been a bit baffling and is proving to be a rather slow process. We aren't sure why the consultant concluded that she isn't insulin resistant. We'd like to get a private insulin test but have some questions:
1. Will this be able to accurately show whether she is producing enough insulin or is insulin resistant?
2. Is it best to fast for the test? Her fasting blood sugar readings are always fine - she just has high post pradinal figures when eating carbs. I don't know whether this affects when you should get the blood draw
2. Are there any other tests that would be worth getting?
 
Adam01 said:
We'd like to get a private insulin test but have some questions:
1. Will this be able to accurately show whether she is producing enough insulin or is insulin resistant?
2. Is it best to fast for the test? Her fasting blood sugar readings are always fine - she just has high post pradinal figures when eating carbs. I don't know whether this affects when you should get the blood draw
2. Are there any other tests that would be worth getting?
Click to expand...

She would likely need more than insulin test.

Those with Type 1 may be able to give better guidance on the range of test to perform.
 
If you want a test to see if you are type 1 the test you need is a GAD test. This is a test to see if you have the antibodies associated with type 1 diabetes. There are about half a dozen antibodies but I think GAD is the one most commonly tested for. I'm not sure if the test is expensive. But I do know there is usually a bit of a wait for the results. My understanding is that all antibody tests are run in one lab, in Exeter. I don't know if it would be available privately. There's no need for a family history to have it, I certainly had a GAD test with no family history simply because they were concerned I wasn't type 1 due to hypos.

Antibody testing doesn't give a definitive answer as to type of diabetes. About 25% of type 1s are antibody negative. So antibody negative doesn't mean you aren't type 1. But antibody positive does mean you definitely are type 1.

The other test that would assist in determining if there is insulin resistance of just a lack of insulin is a cpeptide test to see how much insulin is being produced. That's not an insulin test, but it's a cheap easy test to run either urinary or blood test. And it tests the same thing.

What the consultant may have been talking about when he asked for a family history for test to be run is MODY, a genetic diabetes. The test for that would be genetic testing.
 
She needs a c-peptide test which will show whether her insulin is high (indicates T2) or low (indicates failed beta cells). It's normally a fasting test. I had mine done privately as a fasting test and it showed my insulin to be right at the bottom of the range. The GAD test if positive will show that GAD antibodies are present which is the common cause of beta cell death. There are other causes of beta cell death such as viruses. The consultant should be doing at least the c-peptide and GAD which I had done and his approach seems strange? BTW the c-peptide test result shouldn't be taken as an accurate measure but a guide to whether the insulin is too high or too low and hence indicate treatment options.
 
I agree about the c-peptide and GAD tests.
An insulin test could be beneficial but I'm surprised that during the OGTT test it wasn't done.
Was it a two hour OGTT?

Tests for other metabolic conditions include a five hours fasting extended OGTT, a breakfast test, also to eliminate other conditions a 72 hours fasting test.
There is also tests for intolerance to certain types of foods, say a wheat or gluten intolerance.
The way you describe the beta cells dysfunction, will give your doctors a plan for more tests to get the diagnosis.

I have a rare condition that causes my pancreas to create more insulin than necessary. This is due to how my beta cells are triggered by food.
This is controlled by a very low carb diet.

Beta cell dysfunction with insulin resistance is synonymous with types of diabetes.
So I wouldn't rule out anything until more tests are done.
Beta cell without insulin resistance, seems to be some condition that is rare. But you can have insulin resistance and have a low BMI.

However the lower the carbs, I would believe that would help in the meantime.

Best wishes, let us know how you get on.
 
Thank you all for your helpful replies. We don't think she's got type 1 even though I know it can come on more slowly in adults (learnt from this site!). We figured her blood sugar would be far higher by now. It's also never been mentioned as a possibility by the Endocrinologist. The term 'MODY' as @catapillar mentioned was referred to I believe.

She had an extended GTT (5 hours). Her last reading was 6.8 so any kind of low blood sugar condition seems unlikely? When she got home about 6/7 hours after the drink though she did feel a bit odd and tested her blood sugar and it was 3.4. This never happened after carby meals though (when she used to eat them). So yeah basically we would like to get a better idea of what could be going on, mainly due to potential implications for our child.
 
I am guessing your wife is British, I am confident she is entitled to be reasonably tested for both Type 1, 2 and other without private intervention; this is her health and should not be bartered with, this is surely why we pay taxes and have the NHS. As she has had gestational diabetes and the glucose test was presumably a figure after 2 hours, there looks to be plenty of rationale for her HCP to justify investigatory tests.

I would write a letter to the HCP and obtain an appoitment to discuss. if that didn't work I would phone the local health authority to check if the HCP is following the correct protocol.
 
Mbaker said:
I am guessing your wife is British, I am confident she is entitled to be reasonably tested for both Type 1, 2 and other without private intervention; this is her health and should not be bartered with, this is surely why we pay taxes and have the NHS. As she has had gestational diabetes and the glucose test was presumably a figure after 2 hours, there looks to be plenty of rationale for her HCP to justify investigatory tests.

I would write a letter to the HCP and obtain an appoitment to discuss. if that didn't work I would phone the local health authority to check if the HCP is following the correct protocol.
Click to expand...
Thank you. Yes this was a 2 hour result and the 90 minute result was the same. Would it be correct to say that if the result was over 11 they would have to investigate further? I suppose with her result she doesn't technically have diabetes, though the Endocrinologist did say her result was abnormal.
 
Hi Lamont sorry to highjack this thread but I've been reading you posts and wanted to message you but I can't find how to do this when I looked at you profile.

I've been struggling with erratic blood glucose for years and had ogtt done and these measure insulin and glucose and it shows my insulin at around 90 minutes shoot extremely high. I've been trying everything diet wise but I'm at my wits end and really want to get to the bottom of what's going on and get the right treatment. I've also been tested for insulinoma. I do have Addison's disease which I suspect contributes to glucose going low sometimes due to low cortisol levels BUT I know the main problem is the glucose insulin system. I've been testing for years but I'm trying so desperately to find a hospital who will really investigate what's going on with me as it's effecting my life all day every day. Can you give any advice please.

He's some info that might help a bit. Thanks so much for your time.

I'm 33 and For years since age 14 I've had reactive hypoglycaemia confirmed on my glucose meter and a few years back on glucose tolerance test. They measured insulin at the time too and said it was excessively but my glucose was borderline.

To cut a long street short I get a lot of low blood glucose levels, so I would eat something it would go high at about 1 hour day to 10mmol and then drop low by three hours say to about 3mmol. I was so tiered of this I decided to go low carb but I now realise I went to low, for a year I've been only eating salad and carrots as my carbs and absolutely no other carbs sugar nothing, it was nice not to experience the dramatic swings but I was always be running between 3.5-4.5 all day and I felt I was drained. Sometimes it drops below 3.

Iv recently decided I need to eat more carbs and actually try to sort out properly any underlying problem there may be.

I'm only eating a max 4 tablespoons of whole grain rice or two small potatoes now with a meal.

So these are examples of what's been has happening since iv introduced some carbs the past few months.

For lunch I usually eat salmon, cucumber lettuce I egg and 3 tablespoons rice and I feel very sleepy after.

Dinner I eat similar kind of things meat fish with veg and three nights ago I eat roast chicken carrots green beans and 3 small roast potatoes I felt extreme fatigue fell asleep and my partner tested my glucose and it was 14.8 at 90 minutes.
I woke and felt extreme hunger and had to eat so instead of binging on carbs I eat bacon and egg.

Last night I eat a small bowl of high protein cereal and a small bag of walkers plain crisps as I keep craving salt and I was very hungry after dinner again , I then Got very sleepy and went to bed This morning my fasting is 6.8 and when I was eating no carbs it would run in low 4

I'm finding when I don't eat my glucose gets too low or it stays in the lower numbers but as soon as I eat anything with carbs I feel unwell. But if I eat low carb I just run at nearly hypo and have no ebergy either and constantly feel hypo symptoms like fatigue, can't think clearly, irritable, shaky this is why iv decided to increase the carbs a small amount but now I'm getting the high symptoms but not as much lies

Here's symptoms I have but unsure if linked at all

Excess sleeping after eating any carbs apart from salad

Blurred vision especially in the evenings can't see the tv properly or read the writing on it

Mood swings

Breaking out in sweats (I usually find it hard to sweat)

Excess hunger after meals

Underweight,( I thought you put on weight but I'm under and can't keep it on)

I don't feel excessly thirsty but if I don't drink 2 litres a day I feel very dehydrated.

I don't think I go to wee any more than other people. And I do drink 2 litres water a day so I would wee

Many thanks for reading my lengthy post and your help would be much apreciated. Thanks



Lamont D said:
I agree about the c-peptide and GAD tests.
An insulin test could be beneficial but I'm surprised that during the OGTT test it wasn't done.
Was it a two hour OGTT?

Tests for other metabolic conditions include a five hours fasting extended OGTT, a breakfast test, also to eliminate other conditions a 72 hours fasting test.
There is also tests for intolerance to certain types of foods, say a wheat or gluten intolerance.
The way you describe the beta cells dysfunction, will give your doctors a plan for more tests to get the diagnosis.

I have a rare condition that causes my pancreas to create more insulin than necessary. This is due to how my beta cells are triggered by food.
This is controlled by a very low carb diet.

Beta cell dysfunction with insulin resistance is synonymous with types of diabetes.
So I wouldn't rule out anything until more tests are done.
Beta cell without insulin resistance, seems to be some condition that is rare. But you can have insulin resistance and have a low BMI.

However the lower the carbs, I would believe that would help in the meantime.

Best wishes, let us know how you get on.
Click to expand...
Hi
 
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