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Second OGTT after 5 years

Discussion in 'Ask A Question' started by AnnInDenmark, Apr 28, 2017.

  1. AnnInDenmark

    AnnInDenmark Type 2 · Well-Known Member

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    I just had my yearly check and when the GP saw that my HbA1c is down to 36, she said that she didn't think I was diabetic at all.
    None of the doctors I have seen since diagnosed 5 years ago ever asked about my diet, and I never told them that I eat LCHF.

    So now I have to do another OGTT (Oral Glucose Tolerance Test).
    I realize that I have to eat like a non-diabetic for a couple of days before the test, and as I have only had max. 20 carbs a day for years, I will probably feel awful while doing that.

    My question is if it is better to slowly up my carbs during a week or so, or just go full high carb for 2-3 days? I imagine that the body will be shocked if it is suddenly fed a lot of carbs, but I don't know how it will react, as I haven't strayed once in those years.
     
  2. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    I am just guessing with this, but my thought is it must be better to build up gradually so as not to shock your system too much or you may feel really ill. It is essential though if you want an accurate OGGT. I don't envy you at all.

    Are you convinced you actually want this test? You've been very low carb for 5 years and haven't strayed (which is brilliant by the way) and that is why your HbA1c tests are so good. You know that, we know that, your doctor doesn't know that.

    You may have cured yourself, you may not have, but does this actually matter to you? If it doesn't matter to you, then why take the test and put yourself through a few weeks of what may be hell for the sake of your doctor knowing? You know you have everything under control and are perfectly happy with your diet. Maybe you could confess your diet to your doctor - he may be in agreement with it, you never know!

    If it does matter to you, then you do need to do the test.
     
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  3. BarbaraG

    BarbaraG Type 2 · Well-Known Member

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    OTOH, if you don't carb up before the test, you will probably fail it spectacularly. That will put paid to your doctor saying you don't have diabetes.
     
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  4. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    Great idea!
     
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  5. Brunneria

    Brunneria Other · Moderator
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    If you decide to go ahead with the test (it should be YOUR choice) then I would give it significantly more than a couple of days of more carbs to give your body time to ramp up its insulin release. A week or more...

    I did this a couple of years ago. I decided to enjoy myself, on holiday, and tried to arrange a controlled carb 're-entry'. But in the week i ate more carbs, my body stubbornly refused to oblige. Spikes remained absurdly high after comparatively small amounts of carbs. Hopefully yours would respond quicker, but just in case...

    What is the purpose of the test? Is it just that your doc is refusing to accept another doc's diagnosis?
     
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  6. Alison Campbell

    Alison Campbell Other · Well-Known Member

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    I will never have another OGTT, I felt so ill during my first one and I was not even low carb.

    My DN strangly suggested that I have another when my HBA1C went up and I told her not a chance.
     
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  7. Mbaker

    Mbaker Type 2 (in remission!) · Well-Known Member

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    You and I have the same HbA1c. Right now you will be enjoying the "fruits" of your hard work. It is both simple and hard to achieve what you have done. Simple in so far as less carbs and sugar, hard as in it takes discipline. If it were me I would not do this administrative exercise, as your body is already behaving in a non-diabetic manner. Not a perfect analogy but a recovering alcoholic would not be encouraged to have a drinking binge to see if they could avoid drink the next day.

    You are already as tough as nails so my 2 pennies will not unduly sway you, as you already have strength of your convictions. Whatever you choose to do be happy.
     
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  8. pleinster

    pleinster Type 2 · Well-Known Member

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    Seriously, you are doing great...why change things to try to "fail" a test so you can be diagnosed based on that and ultimately, if your doctor knows what he is doing, told to eat less carbs? Stick to what you are managing. if you are really curious get a meter and test yourself before and after some lucozade or a packet of wine gums! Stay the way you are.
     
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  9. AnnInDenmark

    AnnInDenmark Type 2 · Well-Known Member

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    @Bluetit1802
    @Brunneria
    Thanks for your replies.
    It is my choice to take the OGTT. I certainly can say no, but if I don't "prove" that I have diabetes, I will no longer get my yearly HbA1c, retinopathy, and neuropathy tests, and I would like them to continue.

    I don't look forward to having to eat a lot of carbs, and I would prefer to have as few high carb meals as possible, but I am afraid of how my body will react if it all happens too sudden.

    Luckily the test is not set on a fixed date. I can just show up at the lab whenever I want, and have it done, which means that I have time to prepare myself both physically and mentally.
    Instructions from the lab is to eat a high carb meal the evening before the test, fast at least 8 hours, not to drink any alcohol, and not to drink more than 2-3 glasses of water during fasting. I don't think that one meal is enough.
     
  10. AnnInDenmark

    AnnInDenmark Type 2 · Well-Known Member

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    I am not sure that I will fail the test if I don't carb up, because my FBG is in non-diabetic range, 3.8-4.3, and bs has to be at least 11 after 90 minutes for the test to be positive. I don't know if I will have that high a rise.
     
  11. AnnInDenmark

    AnnInDenmark Type 2 · Well-Known Member

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    Your "tough as nails" made me chuckle. I take it as a compliment. Thank you.
    When I first started reading this forum, I didn't understand what people meant by "craving carbs". I never craved a certain kind of food. Lucky for me I guess, as I don't need as much discipline as many others.
    There is no doubt in my mind that I will have no trouble at all going back to eating LCHF after the test.
     
  12. AnnInDenmark

    AnnInDenmark Type 2 · Well-Known Member

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    If I was younger, or wealthy, had a family, and didn't have rheumatoid arthritis, I wouldn't do it.
    But next year I will become "an old aged pensioner" as one Claude Jeremiah Greengrass called it, and at some point I may need the help of strangers to get the right food. That will be easier if I am registered as diabetic. I am thinking about the future.

    I don't doubt that I have diabetes. This morning I decided to test how much I would spike on some higher carbs. I bought a focaccia bun thingy an had it for an early lunch. Maybe not the best choice as it also contained a lot of fat, as did my breakfast.

    It had 37g carbs
    Rise after:
    60 minutes: 4.4
    90 minutes: 4.9
    120 minutes: 6.5
     
  13. AnnInDenmark

    AnnInDenmark Type 2 · Well-Known Member

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    It is not the test in itself that I am afraid of. It is the carbs I have to eat prior to it. Just thinking about it gives me a headache.
     
  14. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    You say you want to fail the test. No-one can say if you will fail or pass the test, but if you stick to your very low carb and do not carb up, you have more chance of failing it. Why not have a go at home with 75mg of glucose rather than a higher carb meal?

    In the UK, even if we have been taken off the register, we still get our annual retinal screening. (These are the instructions given to GPs) I don't know how it works in your country, but when I was nagged about coming off the register my nurse assured me I would still have annual HbA1c and foot checks because of being deemed to be "at risk". Perhaps it is worth investigating?

    By the way, I declined the offer to come off the register because currently I have 6 monthly blood checks and I would be moved to annual if I came off it, so I do understand your thinking.
     
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  15. Totto

    Totto Type 2 · Well-Known Member

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    Hi @AnnInDenmark, I'm in a similar situation with a HbA1c of 33 and a very stupid diabetes nurse. I haven't made my mind up yet but will discuss it with my GP. I was diagnosed a few years ago with an OGTT of 13.8 at two hours (20.6 at one hour) and am not very keen to go through that experience again.

    As far as I can understand there are problems with the HbA1c test as the amount of Hb can differ as can the actual type of Hb and both will affect the result, whereas the OGTT is fairly reliable.

    If my GP is very insistent I might go ahead and have the test, provided I can get some further tests done at the same time, like C-peptid for example.

    What if they took a more scientific approach to blood glucose levels and asked us how we have managed to achieve this level of control? They might even learn a thing or two.
     
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  16. dbr10

    dbr10 Type 2 · Well-Known Member

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    I just wonder whether you need to change anything. They will give you lucosade and it will send you sky high after 2 hours.
     
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  17. dbr10

    dbr10 Type 2 · Well-Known Member

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    I was never told anything beforehand.
     
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  18. Alison Campbell

    Alison Campbell Other · Well-Known Member

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    Thats weird, did other people get lucosade, I got some horrible syrup stuff.
     
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  19. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    They perhaps assumed you were eating a lot of carbs.
     
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  20. BarbaraG

    BarbaraG Type 2 · Well-Known Member

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    My hunch is that both the test instructions AND the "normal" levels are for people who eat a standard, i.e. high carb, diet.

    Long term low carbers who are not diabetic often find their fasting BG goes up, and they get worried about it. The explanation is physiological insulin resistance, aka adaptive glucose sparing. When you're not supplying your body carbs all the time, it saves them for the tissues which have to have glucose. This manifests as reduced insulin sensitivity in muscles, but is completely different from the insulin resistance underlying T2D, where the liver is the main culprit.

    I speculate that if OGTT's were done on people who have always had normal insulin sensitivity but who eat low carb, there would be a different set of values recognised as normal. If you would never normally eat anything like 75g glucose in a whole day, the fact that you spike massively when they force you to drink it in one go is neither here nor there.
     
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