Thoughts on my OGTT graph?

I

IncogKeto

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I realise that forum members aren't in a position to offer a diagnosis but I'd be interested in knowing people's opinions on this graph. You can probably work out what I'm thinking by where in the forum I've chosen to post this.

Some details regarding the process:
I'd allowed the Libre 2 sensor to bed in for 24hrs before activating it.
I'd not been on a low carb food intake during the 3 days prior.
Last meal at 7pm the evening before.
No more 'food' until beyond what's shown on the graph.
I'd got out of bed at 10am - corresponding with the slight step on graph.
Rapilose 75g of glucose at 11am.
Finger prick testing every 15min in addition to Libre.

IMG_0091_WEB.jpg
 
Lamont D

Lamont D

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Reactive hypoglycemia
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I do not have diabetes
IncogKeto said:
I realise that forum members aren't in a position to offer a diagnosis but I'd be interested in knowing people's opinions on this graph. You can probably work out what I'm thinking by where in the forum I've chosen to post this.

Some details regarding the process:
I'd allowed the Libre 2 sensor to bed in for 24hrs before activating it.
I'd not been on a low carb food intake during the 3 days prior.
Last meal at 7pm the evening before.
No more 'food' until beyond what's shown on the graph.
I'd got out of bed at 10am - corresponding with the slight step on graph.
Rapilose 75g of glucose at 11am.
Finger prick testing every 15min in addition to Libre.

View attachment 55435
Click to expand...

Does your finger prick test echo the Libre graph?
What meds are you on?

And yes I can see what you are hinting at.
At the point of the low, what action did you take to bring your blood glucose levels back up?

My eOGTT graph, was different but that could be the set up of your device.

What I will say, that it does show an episode of hypoglycaemia if confirmed with a finger prick test, but from that there are more diagnostic tests required for all the differing types of hypoglycaemia or other pancreatic conditions.

Do let us know
 
Lamont D

Lamont D

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No wonder my endo had my eOGTT, repeated, because none of those graphs were similar to mine. One you the tests and grains were only based on two hours tests.

Ho hum!
 
I

IncogKeto

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Lamont D said:
What meds are you on?
Does your finger prick test echo the Libre graph?
At the point of the low, what action did you take to bring your blood glucose levels back up?
Click to expand...

I'm on no medication.

The finger prick data formed a very similar graph to the Libre but offset below, with every finger prick reading being approximately 0.5 to 1.5mmol/L lower. However, I've subsequently bought an additional blood meter for comparison and it suggests that the original meter tends to read low. So at the lowest point during my test, when the original finger prick meter showed 2.4mmol/L, I suspect the level was probably closer to the 2.9 that the Libre was displaying.

I didn't take any action to bring my blood glucose level back up. I had someone watching me though and had some sugary food/drink on standby but ultimately didn't consume any. It's not clear to me whether the increase in blood sugar at the end was a result of me getting nervous through watching the numbers continuing to drop (sweaty palms and light-headedness) or whether my body would have done that anyway.
 
Ronancastled

Ronancastled

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Spiked a bit higher than a healthy non-diabetic, touch of a reactive hypo but then liver did it's job.
 
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Lamont D

Lamont D

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Reactive hypoglycemia
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IncogKeto said:
I'm on no medication.

The finger prick data formed a very similar graph to the Libre but offset below, with every finger prick reading being approximately 0.5 to 1.5mmol/L lower. However, I've subsequently bought an additional blood meter for comparison and it suggests that the original meter tends to read low. So at the lowest point during my test, when the original finger prick meter showed 2.4mmol/L, I suspect the level was probably closer to the 2.9 that the Libre was displaying.

I didn't take any action to bring my blood glucose level back up. I had someone watching me though and had some sugary food/drink on standby but ultimately didn't consume any. It's not clear to me whether the increase in blood sugar at the end was a result of me getting nervous through watching the numbers continuing to drop (sweaty palms and light-headedness) or whether my body would have done that anyway.
Click to expand...
As is posted above your liver intervened, posh name glucogenisis.
It would be prudent to continue to monitor and see if your episode of hypoglycaemia develops episodes (plural).
If it does, see your GP about a referral to an endocrinologist.

Do let us know how you get on.
 
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IncogKeto

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Ronancastled said:
Spiked a bit higher than a healthy non-diabetic, touch of a reactive hypo but then liver did it's job.
Click to expand...

What could be the reason for spiking a bit higher?
Is there anything that I can do to 'improve' my body so that it doesn't spike as high under the same circumstances?
Do you believe that my body would have dumped that glucose into my blood (during the dip) at the same point that it did, even if I hadn't been conscious of the falling numbers?
 
Ronancastled

Ronancastled

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Type of diabetes
Type 2
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Diet only
IncogKeto said:
What could be the reason for spiking a bit higher?
Is there anything that I can do to 'improve' my body so that it doesn't spike as high under the same circumstances?
Do you believe that my body would have dumped that glucose into my blood (during the dip) at the same point that it did, even if I hadn't been conscious of the falling numbers?
Click to expand...

First of all I'm only going by the Libre graph which may not be that accurate during the dynamics of an OGTT. I know you did finger pricks as well but note that often venous blood runs lower than capillary as it's closer to large muscle groups.
That said one of the earliest notable disfunctions in T2 is the impairment in 1st Phase insulin response. This normally leads to an increased 2nd phase & hence the relating hypo.
 
Lamont D

Lamont D

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17,753
Type of diabetes
Reactive hypoglycemia
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I do not have diabetes
IncogKeto said:
What could be the reason for spiking a bit higher?
Is there anything that I can do to 'improve' my body so that it doesn't spike as high under the same circumstances?
Do you believe that my body would have dumped that glucose into my blood (during the dip) at the same point that it did, even if I hadn't been conscious of the falling numbers?
Click to expand...

Either insulin resistance or a lower than normal insulin response.
If you have access to the glycaemic index (on line) or the insulin index. That will show you what foods have the lowest or highest typical response.
But the lower the carb load,, the lower the spike.
A!so, there are meds that are used to improve insulin response.
But dietary methods shou!d be used first.

A liver dump is a normal response for the majority of people. It is usual, when energy or blood glucose levels are low.
 
Oldvatr

Oldvatr

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IncogKeto said:
Unfortunately, I'm not sure what to make of all that.
Click to expand...
Sorry, i forgot you have an aversion to reading scientific reports. However, the paper I posted may be helpful to others reading this thread who are not as knowledgeable about OGTT.

In response to your OP, I am not convinced that you are not seeing artefact being generated either by the method of test, or of the CGM meter itself. I have seen at least 3 studies now where a CGM was used to perform an OGTT, and in each case the cgm was found to give unreliable results. Abbott themselves advise using a fingerstick test to check accuracy and also to confirm hypos. There must also be reasons why cgm is not being used widescale to provide closed loop control of insulin pumps. It will come in time, but does not seem to be available yet.

A fingerstick meter is accurate to be within +/- 15% of reading above 5 mmol/l So a blood sample of 10 might be reported as 8.5 or 11.5 mmol/l and be considered accurate. The Libre accuracy is +/= 12.5 % so is similar. When comparing one against the other then there could be 55% difference between them and both would be considered accurate, and you will not know which way the error goes. Contrast this with the lab version of the OGTT which uses a YSI 2300D (or nowadays the 2900D) reference analyser which has <2% error of the venous blood samples.

We discussed the time delays before, but I have seen reports that the CGM has a delay of about 12.5 minutes while the glucose is rising, but up to 25 minutes when it is falling when compared to venous blood sampling. Abbott state a delay of 15 minutes for steady state reading. So under OGTT test, these differing delays will introduce skew into the waveform shape and distort it.
 
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