What next?? Nurse wants a GTT

Outlier · Dec 15, 2022

You sound like someone who is eminently sensible and you have worked out a health regime that suits you well. You show no signs of being diabetic on this regime, and probably aren't diabetic anyway.

Your nurse sounds deeply and spectacularly ignorant, which as you've found does not stop some people from being hectoring, bullying, and just plain wrong. That's her problem not your problem. I wonder if she has "targets" to meet? Again, her problem not yours.

I think you are doing really well.

HSSS · Dec 15, 2022

Outlier said:
Your nurse sounds deeply and spectacularly ignorant, which as you've found does not stop some people from being hectoring, bullying, and just plain wrong. That's her problem not your problem. I wonder if she has "targets" to meet? Again, her problem not yours.

Sadly it becomes the problem of all the patients who believe her nonsense or who feel terrible as a result of her ignorance and bullying.

Brunneria · Dec 15, 2022

Oh boy.

congrats on having done the HbA1c test. I hope you are now completely reassured?

Your nurse sounds like she is a potentially dangerous liability.
@HSSS has already given you useful links on why your nurse’s diagnostic practices/beliefs are against current NHS guidelines, so it just remains for me to give you accurate info on how Atkins died.

Robert Atkins (physician) - Wikipedia

en.wikipedia.org

Atkins slipped on an icy pavement in New York, banged his head and died of the injury days later, in hospital.
at the time of his injury he had cardiomyopathy, caused by a virus, not his diet.
Anti-Atkinsers thought it would be a hoot to say he died from bad eating, and their comments went viral
- and now, half the world, and misinformed nurses, spout the lies as if they were gospel.

I suggest you pass the links to your nurse, and remind her that passing incorrect information, scaremongering and misleading is actually malpractice.

Also, in case you are interested, as I understand it, the GTT is the way diabetes used to be diagnosed. They were phased out several years ago when the WHO decided that the HbA1c was a better (cheaper) more easily standardised test.

I have had several of these GTT tests, at 2 different surgeries, and been dismayed at the various different procedures used. Different drinks (glucose in water, lucozade, premixed sickly fruit drink. Different instructions (fasting, not fasting, forbidden to walk between tests, sent home on foot and told to come back 2hrs later). Different timings used (blood drawn at 0 and 120mins, at 0 and 135mins, and 0, 60 and 125mins).
Once, the 2hr blood draw was delayed by 15 mins, and I ‘passed’ the test by a mere 0.1 mmol/l
(and we all know how much our bg can drop in 15 mins!)
when i asked for the mistiming to be taken into account, they said the times were fine and my results were non diabetic, and ‘we’ll call you in 12 months for a retest.’
A year later, I was told ‘oh, we don’t do GTTs any more. The HbA1c is much better’.

basically, don’t let the woman bully you, and try to ensure she hasn’t marked your notes in some way that might affect any future treatment or prejudice any future healthcare worker.

Lamont D · Dec 15, 2022

EllieM said:
Sorry if I'm late to the party (and I appreciate I'm a T1 cross posting to someone who is at genetic risk of T2) but I thought that diabetic complications (damage to eyes, nerves etc) were caused by high blood sugars. Indeed, my understanding of the reason that the diabetes diagnosis hba1c is set at 48mmol/mol or 6.5% is because that was the level below which there was very little retinopathy.

So if you are avoiding higher bgs by avoiding carbs I can't see why the NHS would want or need to waste resources on testing for complications that you aren't at risk of getting.

And my understanding of GTTs is that you have to "carb up" for several days before to get a valid result, so why on earth would you want to do that?

It does for some. But not all, it all depends on how the endo is understanding the patients issues with carb intolerance and insulin response, first phase, or insulin resistance and insulin response, also other hormonal imbalance in response to glucose.
My five or six eOGTT 's were all fasting, the last three were for insulin response and insulin overshoot due to clinical trials for a drug for weak insulin first phase response.

For others, a non fasting carb controlled OGTT, is to note the difference after high carb glucose on top of a 'normal ' diet. Which is most prediabetics and new T2s.

I'm not certain about gestational diabetes. If course it depends on the patient and what the endo is looking for.
Can someone correct me please on gestational? So I know for future reference.

Lamont D · Dec 15, 2022

Brunneria said:
Oh boy.

congrats on having done the HbA1c test. I hope you are now completely reassured?

Your nurse sounds like she is a potentially dangerous liability.
@HSSS has already given you useful links on why your nurse’s diagnostic practices/beliefs are against current NHS guidelines, so it just remains for me to give you accurate info on how Atkins died.

Robert Atkins (physician) - Wikipedia

en.wikipedia.org

Atkins slipped on an icy pavement in New York, banged his head and died of the injury days later, in hospital.
at the time of his injury he had cardiomyopathy, caused by a virus, not his diet.
Anti-Atkinsers thought it would be a hoot to say he died from bad eating, and their comments went viral
- and now, half the world, and misinformed nurses, spout the lies as if they were gospel.

I suggest you pass the links to your nurse, and remind her that passing incorrect information, scaremongering and misleading is actually malpractice.

Also, in case you are interested, as I understand it, the GTT is the way diabetes used to be diagnosed. They were phased out several years ago when the World Health Authority decided that the HbA1c was a better (cheaper) more easily standardised test.

I have had several of these GTT tests, at 2 different surgeries, and been dismayed at the various different procedures used. Different drinks (glucose in water, lucozade, premixed sickly fruit drink. Different instructions (fasting, not fasting, forbidden to walk between tests, sent home on foot and told to come back 2hrs later). Different timings used (blood drawn at 0 and 120mins, at 0 and 135mins, and 0, 60 and 125mins).
Once, the 2hr blood draw was delayed by 15 mins, and I ‘passed’ the test by a mere 0.1 mmol/l
(and we all know how much our bg can drop in 15 mins!)
when i asked for the mistiming to be taken into account, they said the times were fine and my results were non diabetic, and ‘we’ll call you in 12 months for a retest.’
A year later, I was told ‘oh, we don’t do GTTs any more. The HbA1c is much better’.

basically, don’t let the woman bully you, and try to ensure she hasn’t marked your notes in some way that might affect any future treatment or prejudice any future healthcare worker.

I wasn't aware of your treatment with OGTT 's.
When going through mine, my endo was quite clear to the sister who oversaw mine, same one for all.
How can there be different aspects of a clinical test?
There must be supervision. There is real concern for patients safety. The concern for hypos and symptoms of high then low blood sugar crashes. Need I go on?

I'm shocked!

It's a wonder you didn't create a fuss! Bring
Nearly said bully the nurse then @Brunneria. Ha!!

Best wishes.

Ryhia · Dec 15, 2022

Long before I was diagnosed with diabetes, I had to have a medical after securing a job in the NHS. I had been low calorie dieting for a few weeks but fell off the wagon the day before the medical and just ate everything in site that was sugar related, Ice cream, cakes, sweets, all sorts. A urine test taken at the medical showed sugar. I explained what I had eaten and all they did was arrange another urine test, which showed no issues. I cannot understand what all the fuss was about with your HCP. 8.8 after porridge is not bad at all, when I tried porridge mine went up to 9. something after an hour. I wonder what her bloods would show given the same experiment.

My doc told me that the HbA1c was the go to method to diagnose diabetes so why is an HbA1c not acceptable to her? Its NICE guidelines after all. Sounds like her nose has been put out of joint because you are taking the initiative and trying to keep healthy in your own way. Good on you!

I come from a very diabetic family so to try to prevent the onset of diabetes I was eating to the Eatwell plate guidelines and had done so for years. How can it be ok for me to eat Eatwell to stave off diabetes yet you are being castigated for eating a low carb diet with the intention of doing the same thing. It's only by following a low carb way of eating that I am now in remission. Had I known about low carb instead of following recommended guidelines, I do not think I would be diabetic now. A couple of years ago, I came across a 1949 cookbook which contains a recommended diet for diabetics. I've pasted this below. Turns out the recommendation was to eat low carb!

Bearing in mind what you have gone through already and the stress it has caused you, I think I would be asking my GP if I could see someone else. As others have suggested, I would also be wanting to see my notes.

HSSS · Dec 15, 2022

Lamont D said:
It does for some. But not all, it all depends on how the endo is understanding the patients issues with carb intolerance and insulin response, first phase, or insulin resistance and insulin response, also other hormonal imbalance in response to glucose.
My five or six eOGTT 's were all fasting, the last three were for insulin response and insulin overshoot due to clinical trials for a drug for weak insulin first phase response.

For others, a non fasting carb controlled OGTT, is to note the difference after high carb glucose on top of a 'normal ' diet. Which is most prediabetics and new T2s.

I'm not certain about gestational diabetes. If course it depends on the patient and what the endo is looking for.
Can someone correct me please on gestational? So I know for future reference.

The idea of carbing up (to normal levels seen on an eatwell diet not extreme ones) in the days before an OGTT is to avoid artificial failure caused by the diet with adapative glucose sparing as described above. It’s not a matter of fasted or not because as you say what they are looking at may well vary.

Indeed if I eat an unexpected and large amount of glucose I not only get the diabetic and expected rise but I believe it is larger than it was if I were to be eating a “normal” diet Then I get the insulin overshoot again it would appear because I am not used to the demand made.

Outlier · Dec 17, 2022

I always fast before blood tests now, having once been told it was a non-fasting test and then being criticised for my readings.

Oldvatr · Dec 17, 2022

Outlier said:
I always fast before blood tests now, having once been told it was a non-fasting test and then being criticised for my readings.

I followed NHS advice regarding non fasting blood tests, and this resulted in several aborted tests because the lab was unable to take a valid reading because I had eaten some fat, and my blood was 'milky' due to high levels of chylomicrons. So I now always fast before a test.

Oldvatr · Dec 17, 2022

Just a quick note: The OGTT test does not test first stage insulin response. This is an event that occurs in the first 10 minutes of imbibing thr glucose, and is generally over by time=15 minutes. It is a very sharp spike of insulin. The effect of this spike on blood glucose is not detectable using glucose meters, and is actually only visible during a lab based assay which measures insulin levels or c-peptide levels., The other way of doing a GTT is the IVGTT which uses a venous infusion set to control and inject the glucose. But this method is bypassing the digestive process, so is not exercising the full enzyme regime or pathways that control insulin, and the results are different.

The standard OGTT test for gestational diabetes does not test in the early phase, and generally is based on a single result taken at the 2 hr mark.

Lamont D · Dec 17, 2022

Oldvatr said:
Just a quick note: The OGTT test does not test first stage insulin response. This is an event that occurs in the first 10 minutes of imbibing thr glucose, and is generally over by time=15 minutes. It is a very sharp spike of insulin. The effect of this spike on blood glucose is not detectable using glucose meters, and is actually only visible during a lab based assay which measures insulin levels or c-peptide levels., The other way of doing a GTT is the IVGTT which uses a venous infusion set to control and inject the glucose. But this method is bypassing the digestive process, so is not exercising the full enzyme regime or pathways that control insulin, and the results are different.

The standard OGTT test for gestational diabetes does not test in the early phase, and generally is based on a single result taken at the 2 hr mark.

When my endo was going through the graphs from my eOGTTs with me, he pointed to the quick spike line, he said that was because my first phase insulin response, was weak. In other words, the graphs showed that the insulin wasn't enough for the 75g of glucose solution. It wasn't insulin resistance, because of every test was the same until I started taking the gliptin to assist the insulin. This was corroborated with a insulin, c-peptide test , drawn from a cannula.
I suppose a standard two hours OGTT, does include insulin testing, which is ridiculous when you consider one of the reasons for T2 is high levels of circulating insulin and hyperinsulinimia!

Oldvatr · Dec 17, 2022

Lamont D said:
When my endo was going through the graphs from my eOGTTs with me, he pointed to the quick spike line, he said that was because my first phase insulin response, was weak. In other words, the graphs showed that the insulin wasn't enough for the 75g of glucose solution. It wasn't insulin resistance, because of every test was the same until I started taking the gliptin to assist the insulin. This was corroborated with a insulin, c-peptide test , drawn from a cannula.
I suppose a standard two hours OGTT, does include insulin testing, which is ridiculous when you consider one of the reasons for T2 is high levels of circulating insulin and hyperinsulinimia!

The standard OGTT test does not measure insulin. That is only done during research studies, and also funnily enough the test subjects are normally rodents. who actually have two insulin secreting organs but are compared to human pancreas. Strange that! The human OGTT is blood sugar levels only, and in general it is done with standard fingeprick testers rather than a venous sample for the lab. So there will be a potential +/- 15% inaccuracy there for a start. I am surprised if a first phase is seen with a standard Oral test since the effect is swamped by the slow digestive process affecting timings. The IVGTT is used in research since it is a definite step function hitting the pancreas at a known time.

Lamont D · Dec 17, 2022

Oldvatr said:
The standard OGTT test does not measure insulin. That is only done during research studies, and also funnily enough the test subjects are normally rodents. who actually have two insulin secreting organs but are compared to human pancreas. Strange that! The human OGTT is blood sugar levels only, and in general it is done with standard fingeprick testers rather than a venous sample for the lab. So there will be a potential +/- 15% inaccuracy there for a start. I am surprised if a first phase is seen with a standard Oral test since the effect is swamped by the slow digestive process affecting timings. The IVGTT is used in research since it is a definite step function hitting the pancreas at a known time.

I only know by experience of my eOGTTs.
Mine was venous blood and sent to a laboratory for detailed analysis.
however finger prick tests were also done on a glucometer which I'm certain only a few people could afford, it looked like a tricorder from star trek!
Every one of my graphs were very similar.
I think with the steep climb of my graphs and the analysis, due to the numerous graphs, he has seen. That everything pointed to a weak insulin response.. ..
And with the final results from having the gliptin. The difference between before and after were very good.
From over 12 to 14mmols spikes on my first couple of glucose tests. From pre test 4mmols pre test.
To 8mmols on my final test.
However, this was still not enough to prevent the insulin overshoot, and I still went hypo!.
The trigger point is just above normal levels, somewhere around 6-7mmols.
This means my intolerance to carbs is very low, and avoidance is the best treatment.

Oldvatr · Dec 17, 2022

Lamont D said:
I only know by experience of my eOGTTs.
Mine was venous blood and sent to a laboratory for detailed analysis.
however finger prick tests were also done on a glucometer which I'm certain only a few people could afford, it looked like a tricorder from star trek!
Every one of my graphs were very similar.
I think with the steep climb of my graphs and the analysis, due to the numerous graphs, he has seen. That everything pointed to a weak insulin response.. ..
And with the final results from having the gliptin. The difference between before and after were very good.
From over 12 to 14mmols spikes on my first couple of glucose tests. From pre test 4mmols pre test.
To 8mmols on my final test.
However, this was still not enough to prevent the insulin overshoot, and I still went hypo!.
The trigger point is just above normal levels, somewhere around 6-7mmols.
This means my intolerance to carbs is very low, and avoidance is the best treatment.

You seem to have been on this version of the OGTT

Comparing glucose and insulin data from the two-hour oral glucose tolerance test in metabolic syndrome subjects and marathon runners - PubMed

Glucose is the main energy source of the body's cells and is essential for normal metabolism. Two pancreatic hormones, insulin and glucagon, are involved in glucose home-ostasis. Alteration in the plasma glucose and insulin concentrations could lead to distinct symptoms and diseases, ranging...

pubmed.ncbi.nlm.nih.gov

It is a special hospital based test that needs access to the labs, and is not the sort of test given at GP surgeries or public screening events. The 5 insulin measurements are the key that allows insulin resistance to be evaluated. But the quickie 2hr NHS test for diabetes is not capable of providing diagnosis which is why the NHS has swapped over to the HbA1c test instead - its cheaper and quicker.

Lamont D · Dec 17, 2022

That is what I was saying about the two hour, it doesn't diagnose the root causes of T2 diabetes.
If it doesn't include the insulin testing, just as an hba1c doesn 't.

My tests must have cost a few more bob than usual!

Mind you I am worth it!

And how much would a week stay in a hospital ward cost to my fasting test?

What next?? Nurse wants a GTT

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