OGTT test - HbA1c: HELP

Ronancastled said:

Greetings @sgiossi
Congrats on dropping your A1c.
In regards to your OGTT, did you eat more carbs in the 3 days preceeding, the advice is to eat >150gs of carbs in the days before the test.
If you were eating low carb then the results are skewed.

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Oldvatr said:

Your ketones are consistent with a low carb diet, and nothing to worry about. That reading indicates a low to medium level of ketosis.

The OGTT result is not startling, and only slightly over the threshold. Here in the UK, an OGTT is only really used for testing for gestational diabetes, and is not used for general diagnosis of diabetes. The oral GTT is dependant on many metabolic factors, and is not an exact evaluation. The intravenous IVGTT is more accurate but is rarely used nowadays.

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Lamont D said:

The doctors will be looking at other results with the OGTT.
Sometimes the two hours isn't a good diagnosis tool of what is going on because, depending on your own individual digestion system, the spike could be different from others. Early or late depending on your first phase insulin response.
If your getting regular normal fasting BG levels everyday, maybe knowing why the the prediabetic diagnosis?
Perhaps as you say too many carbs over a period that the hba1c covered.
Most doctors go by the hba1c levels for a T2 of prediabetic diagnosis, but it doesn't answer all the questions.

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HSSS said:

No one test is perfect or addresses every need.

Eg fasting blood glucose is subject to something called dawn phenomenon. That’s a normal and natural process whereby when the liver senses lower glucose levels it adds a bit more to the blood for energy. The most common time this happens is after a longer fast between meals such as overnight. Everyone has a bit of this. Ideally it stops as soon as we are up and able to fend for ourselves. In some people it can be a bit slow to switch off. Type 2 commonly have this issue. It has little bearing on what the rest and vast majority of their days readings are. It’s also typically the last glucose measurement of the day to come into line even after the rest of the day has been great for months or even years. Often for type 2 it will remain higher than some expect even with perfect non diabetic hba1c and amazing rest of the day numbers. Hence looking at the total picture not just one aspect of it.

Also fingerprick readings are not so precise as to mean anything at all in the 0.1- 0.2 differences you identify. I’d go so far as the nearest mmol is about the limit of their accuracy (there are formal guidelines but this isn’t too bad a method in practice to understand it). The higher you are the bigger that “allowance” becomes.

hba1c assumes red blood cells of an average lifespan of 12 weeks and the result is weighted more towards recent weeks than more distant ones. If yours live less or more for whatever reason then it gradually becomes less useful. Some medical conditions do this and likely some people have some natural variation too.

As to whether to continue low carb? Well it seems to have had a beneficial effect on weight and hba1c so far. Do you have more weight to lose? How are the belly to hip or hieght ratios? How do you feel eating this way in general? What about markers like triglycerides often fall and any high blood pressure resolving? I’d caution about returning to your old ways completely, as that would likely mean returning to your old weight and hba1c too. Perhaps there’s a bit of wiggle room though depending on how much difference there is between the old and the new ways of eating. Generally to slow, halt, or reverse weight loss it’s advised to add more proteins and fats rather than carbs for those of with type 2.

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