October 16, 2004
Diagnosis and Symptoms, Type 2
Question from Oakland, California, USA:
I recently had a Glucose Tolerance Test (GTT) to check for hypoglycemia, since I typically run very low (in the 40s mg/dl [2.2 to 2.8 mmol/L] sometimes). I have to eat all the time to maintain a normal level. However, as I was leaving the two hour test, the nurse called me on my cell phone and told me to go to Urgent Care because my one hour test result was 191 mg/dl [10.6 mmol/L].
My fasting level that day, after a 12 hour fast, was 89 mg/dl (5.9 mmol/L], though it’s more typically in the 60s or 70s mg/dl [3.3 to 4.3 mmol/L]. I had candy the night before the test. My 30 minute reading was 149 mg/dl [8.3 mmol/L]. My two hour reading was 156 mg/dl [8.7 mmol/L] and I was spilling sugar in my urine. By the time the nurse called, me, though, I had already eaten a PayDay bar because I felt shaky and weird. I thought I was running LOW, not HIGH.
I left to go get lunch while I was waiting for an appointment with a doctor. I had tuna fish on a salad, no carbohydrates and right about the fourth hour after the GTT, I crashed and fell asleep at the restaurant. I stumbled back to the doctor’s office and they put me in a room to sleep because I was swaying on my feet and could barely stand. I woke up in time for my appointment and it was now six hours after the GTT. I managed to have a conversation with the doctor. He said my other blood tests looked okay, but I’d have to wait for the glycosylated hemoglobin test and my thyroid panel to get a real answer.
I went home, and at the 6.5 hour point, after a PayDay bar and that salad, I was 67 mg/dl [3.7 mmol/L] on my glucometer.
My dad is a type 1 diabetic. I have always had problems with low blood sugar, but NEVER with high blood sugar. At home, I’ve never seen anything over 130 mg/dl [7.2 mmol/L] on my glucometer. So, what the heck happened yesterday? Have you ever seen anyone react to a glucose tolerance test by going into diabetic ranges (over 180 mg/dl [10.0 mmol/L]) and then dropping to a complete crash in four hours? I don’t take any drugs so this was all manufactured by my own body. I eat healthy food and exercise all the time, and I’m a normal weight for my height.
What’s going on? Can anyone tell me? I’m very scared that I’m pre-diabetic.
Answer:
The two-hour glucose value of 156 mg/dl [8.7 mmol/L] suggests you have impaired glucose tolerance (also referred to as pre-diabetes). Some people have suggested that hypoglycemia may occur as a preamble to diabetes because of the inappropriate and dysregulated insulin secretion that may occur with type 2 diabetes. However, this is not well characterized. I would suggest you are at risk of diabetes. You need to see a dietician to learn how a diet can help you prevent the marked lows and allow yourself to decrease your risk of developing diabetes. The symptoms you have are the result of your body’s inability to put a brake on insulin secretion when faced with a high glucose level and a challenge.
JTL
