Abnormal, Normal, Abnormal....??

[Shannonsnail]

I'm so confused so forgive the rambling....

I was dx PD 2 yrs ago following two elevated FBG levels (~120 mg/dl). I was told the usual and since have worked at eating better, exercising more and losing weight. I did take Metformin for a while but eventually the gas/cramps got to be too much for me no matter when I dosed, what I had eaten.

I work at a lab so I monitor myself every few months and all of my FBG and A1c results have been normal over the past year. I *thought* I had beaten it....

This past week I had to go to urgent care for an unrelated issue. They drew my blood as part of my care and informed me that my BG was 150. It had been 3.5 or so hrs since I had last eaten (a chocolate/granola bar of 140 calories). I was shocked.

I have read that you can be PD with isolated IFG or IGT. I guess I have flip-flopped. So, obviously what I did worked to get the FBG under control and since my A1c results have been normal I feel like overall my BG is controlled but this newest result has me puzzled.

I have been 'in between doctors' for the last year and am starting with a new one in early July so of course, I am planning to discuss this in detail and hope that she will order a full OGTT so we can see exactly what is going on.

Has anyone had this happen? Any advice?

Thanks,
Shannon

[jps]

You'd think that a small granola bar would come back down to normal in a couple of hours, but the bar is grain and that will sometimes show a later spike. Happens with me if I eat pasta, my 3, 4 or 5 hour is higher than my one and two hour post prandial.

Also, remember, stress can elevate your BS. Going to the urgent care may possibly be part of it, or whatever malady you were suffering from. It's really hard to pinpoint. I think the best way is as how you've done it. Semi-frequent monitoring of some fasting, random and postprandial samples.

Also, remember that an A1c is an average. This is simplistic, but if you are walking around half the day with your glucose at 140 and the other half of the day you are at 80, that will give you a "normal" A1c value, yet the 140 isn't a good number. Variation is a very important factor, but it is completely ignored by an A1c.

Also, some people tend to be higher in the morning, when most fasts are taken. If I do an 8 hour fast and test at 4 pm, it's going to be about 15% lower than if I test at 8 am.

A doctor that won't order an OGTT or A1c or any other routine test at your request isn't worth a grain of salt in my book. Hopefully your new doc will take your concerns to heart and jump on board with you.

[Shannonsnail]

jps: Thanks for the reminder about A1c - I had not thought about it like that, makes sense.

Well, I will eagerly await the dr's appt in 11 days and hope to soon have more answers. I really wish insurance would cover at home testing supplies for PD. It seems like they would want to put more $ towards prevention rather than only treating but oh well, that's another soapbox!

[Shannonsnail]

Just to follow-up, I had my appt with the new dr. Interestingly, she informed me that the OGTT is no longer used to diagnose or manage glucose levels but rather only the A1c is considered so I was unable to get an OGTT ordered. Has anyone else been told this before?

This dr felt that the elevated glucose I had at the urgent care was due to a physical response to the kidney stone pain I was having. Her recommendation was that since my A1c was normal that I just get back on metformin and retest in 2 months (and continue with exercise and losing weight). (I had stopped my metformin due to side effects but in talking with the new dr, realized that my last prescription was either written or filled inaccurately - it was regular instead of ER).

I decided to follow her recommendations but to also purchase my own meter and begin testing for my personal knowledge and benefit.

[jwags]

Whenever you are sick your bg tends to rise on its own regardless of food. Maybe your high reading was due to that. I used to eat those Kashi granola bars all the time before being dx. I thought they were healthy. Now I know better.

[rak1978]

(I had stopped my metformin due to side effects but in talking with the new dr, realized that my last prescription was either written or filled inaccurately - it was regular instead of ER).
.

Have you tried taking the brand name Glucophage instead of the generic? I experience bad side effects with the generic, but not so bad with brand name.

[Shannonsnail]

No, I've only been on generics...may have to look into that. I have been back on the ER formulation for about a week and I am definitely having the same side effects again. I get very bloated, sometimes even while sleeping, and gassy, more burping than anything else. it is really odd and somewhat painful. If anyone has any great tips on how to avoid this let me know.

[rak1978]

Here are some of my personal tips to avoid the indigestion...
(this is my opinion, it's worked for me...take it for what it's worth!)...

1) Use Glucophage, not generic
2) Ease into it...your doctor should have told you this. For instance, I'm on 500 mg 4 x a day, I added 1 pill per week until up to the full dosage. If you go from nothing to full dosage, you'll definitely have some problems.
3) Do not eat a lot of carbs with it. I notice that when I go low carb, I don't have problems. If I eat carbs when taking this, I do have indigestion.

That's my 2 cents.
Good luck!

[genie86333]

I work at a lab so I monitor myself every few months and all of my FBG and A1c results have been normal over the past year. I *thought* I had beaten it....


Unforunately, that's where you went wrong. Once you're pre-diabetic, all you can do is control it...you'll never *beat* it.

You mentioned you test your A1C and your FBG, but you never mentioned testing after food, which is just as important. Your fasting levels may be good enough that they're balancing out small spikes caused by eating certain foods...that means your A1C & your fasting can be fine but you could be having frequent spikes.

Also, blood sugar can be raised by stress, illness, etc, so whatever sent you to the doctor may have raised your blood sugar.

My advice is to get a meter & test 2 hours after each meal, so you can find a list of things which keep your blood sugar at a normal level (under 140 preferrably.) Most people find they have to cut back on or totally avoid grains, like the granola bar or cereal as well as "white" foods: rice, pasta, bread, potato, flour, sugar. After you've done that, keep testing at least once in awhile so you can make sure your numbers don't creep up. And keep it up with the A1C testing at work!

Oops, almost forgot: Welcome to the forum! You'll find tons of great info here.

[Shannonsnail]

Rachel: Thanks! Now that you mention it I am getting the symptoms mostly when I take the metformin at the same time I eat a meal of more carbs, I think I'll switch to my AM meal. My dose is 2x/day (500 mg each) but right now I'm trying just once a day. I'm going to try to make it through this bottle of generic pills (#90) but when I go back in late Sept, if still having symptoms, will ask for a Rx with the 'no generics' marked.

Genie: Thanks- that is exactly what I am doing (testing) - I think you missed my update post. So far I am learning alot but boy are my fingers agitated with me!

[genie86333]

Glad you're learning!

Are you testing on the sides of the fingers? If not, it's less painful that way!

[Larry H.]

Haven't been on for some time. Going on nearly two years now since I discovered I was approaching numbers for Type II. My fasting had also come in over 125 by a few points and once in a while at low 130s a few times. After the news I took proactive changes though self knowledge mostly as the doctors around here all think I am fine. At first my numbers after meals at night could easily be in the 150's to 180's. But after walking daily for two years, and pretty much watching the carbs I numbers 30 or more points less than before. Yesterday the fasting number was 90.

But the point I wanted to make is this. Yes it can be deceiving after you do the right things and get to see good numbers to think that everything is fine. But the other day I got stuck and very late for lunch, we ended up eating hamburgers and fries which I normally never do.. that evening after a low carb dinner, I did have a fat free ice cream but it used something other than splenda for sweetener. Two hours later I had a 158. The next day I did much closer to what I usually do and after a evening meal with fat/sugar free desert, my number was 102. Quite a difference. But it shows that if your prone to reaction to the level of carb intake it will remain so unless you change your eating habits.

I do believe that some amount of improvement may be possible though diet and exercise as far as what the body is able to process, but most likely never returns to perfection.

Larry

[Shannonsnail]

Larry: Thanks for sharing your experience. After a week of testing I've only had a few results I thought were concerning (and pointed to food items I should modify or no longer include in meals) so your post is timely to remind me not to ever think it will go back to complete perfection...the damage has been done and now we manage it.

Genie: Yes, sides of fingertips, still painful! I do have a question though. When you test after a meal, let's say at one hour or two hours - is that after the time you begin to eat or finish eating? I've had other friends ask me this too and did not know how to answer - no one has ever really specified to that level. Thanks!

[GayleM]

Just to follow-up, I had my appt with the new dr. Interestingly, she informed me that the OGTT is no longer used to diagnose or manage glucose levels but rather only the A1c is considered so I was unable to get an OGTT ordered. Has anyone else been told this before?

Hey, Shannon :)
Yes, I have read that. If I recall correctly this was the result of a fairly recent conference on diabetes. Although, I recall it being suggested...not an absolute.

I strongly disagree with using just the A1C. It is an AVERAGE only. If you peak at 200 after a meal but come back down quickly to under 145 (the highest non-diabetics ever go) I believe the math would show you as borderline. In actuality, you would be diabetic given those peaks.

I don't think docs look at this the same way we do. They know it isn't curable, they don't know what causes it (although the CORRELATIONS are definately genetic, maybe weight related, maybe certain skin conditions...who know...I sure don't, there is no history in my family 3 generations back!) and being scientists they want absolutes. And, after all, if you are in the high risk group odds are you will get it anyway and that they have meds for.

So, I don't think the medical community cares about the "when to declare you have it" as much as we do. I question everything my endo tells me, do my own research and ultimately trust the only thing I know will never, ever, be swayed by personal bias...my monitor! :)

Take care!

[jps]

Shannon, the OGTT is still widely available and it is still used all over the place. Perhaps the doctors office or lab they use don't offer it anymore. Which is foolish. It should always be on hand because it is still a standard. Gestational diabetes is still measured by OGTT, an A1c won't tell the docs diddly about gestational diabetes.

I don't know if the GTT cola is available in any health aisles in a store, it may be? It's not a magical drink. It's 75g of glucose dissolved in water. Probably can be concocted at home. Somebody here may have done an OGTT at home and can provide more insight. Might be able to buy a bottle online somewhere too.

The A1c is a pretty good indicator of long term (3 month) control, but it certainly does not paint the whole picture. Not even close. That's why daily testing is your best tool. But to start off with, you really should find a way to get an OGTT performed.