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Medical Forum / Diseases and Disorders / Diabetes / December 2006Results of OGTT
After 1 month of self testing (about 100 total pricks), I had a single high reading of 149, two of 139 and the remainder never cracking 130. These were all 2hr post meal tests. My average was 111. Of the fasting readings, my highest was 119 and my average was 109. Based on this, I felt pretty confident that I fell into the IFG category. Imagine my surprise when my 2 hr GTT was 212! I realize I drank 75g of glucose but never imagined I would go that high. Odd thing is that this was a rise over the 1 hr level (205). These are unofficial tests with my meter - I won't have lab results for 2 days. I tested again in the car at 2hr and 15 minutes and the level had risen to 229. At 3 hrs, it had fallen back to 200. In addition to being surprised and dismayed, I'm also confused. Is there anything that can be read into the fact that my BG didn't just remain elevated, it rose? Could this have a metabolic component to it? Last week, my hA1c was 6.3. That, along with my own finger pricks suggested to me that my day to day levels were just entering the impaired range. Grrrrr. >After 1 month of self testing (about 100 total pricks), I had a single high >reading of 149, two of 139 and the remainder never cracking 130. These were [quoted text clipped - 15 lines] > >Grrrrr. One comment: The NHANES average HbA1c for non-diabetics is ~5.0. Your HbA1c is substantially higher than mine and I am a full-blown, unequivocal 100% diabetic. The latest correlation between HbA1c and 24/7 average blood sugar is: 24/7 Average bG = 35.6 x HbA1c - 77.3 Your 6.3 correlates with a 24/7 average of 147 It's a lousy correlation (R-squared = 0.68) and you may be anomalous but 6.3 is still quite high for a non-diabetic. The fellow who put this web site together has a few odd opinions but his raw data is taken from good medical reports. http://www.rajeun.net/gtt.html#Diabetes and Hypoglycemia ( http://tinyurl.com/c5xqo ) Your home-grown data doesn't seem to fit any of his curves. However, the "standard" curves assume some sort of standard stomach emptying behavior which turns out to be affected by the amount of fluid you take with the 75 gram of glucose. More fluid = faster bG rise, e.g. http://tinyurl.com/5zxzk Regards Old Al > >After 1 month of self testing (about 100 total pricks), I had a single high > >reading of 149, two of 139 and the remainder never cracking 130. These were [quoted text clipped - 48 lines] > Regards > Old Al That's a very useful formula and reference. Thanks for sharing. Pete Romfh Pete Romfh wrote in message <1166041318.186754.208720@j72g2000cwa.googlegroups.com>... >> The latest correlation between HbA1c and 24/7 average blood sugar is: >> [quoted text clipped - 14 lines] > >Pete Romfh There's supposed to be a better one (better R-squared) coming out this month. They actually used continuous glucose monitors to gather some of the data. Oops, the HbA1c refers to values comparable to the "DCCT Standard" Regards Old Al > >After 1 month of self testing (about 100 total pricks), I had a single high > >reading of 149, two of 139 and the remainder never cracking 130. These were [quoted text clipped - 31 lines] > (R-squared = 0.68) and you may be anomalous but 6.3 is still quite high for > a non-diabetic. There's still a lot of variation in reference ranges betwen labs. On my latest bloodwork, 6.3 is the top end of the reference range for "normal" people. Other folks here have reported labwork with a reference range topping out at 5.5. The variation is much much less than when I first got a newfangled A1C tests at a research hospital a quarter century ago! Tim. > There's still a lot of variation in reference ranges betwen labs. On my > latest bloodwork, 6.3 is the top end of the reference range for [quoted text clipped - 5 lines] > The variation is much much less than when I first got a newfangled A1C > tests at a research hospital a quarter century ago! I think you're confusing two things. If I understand correctly, the "normal" range given by labs is for people at that lab who are not diagnosed with DM. That's very different from what's an A1c for someone who truly isn't diabetic. Just because one hasn't been diagnosed with DM doesn't mean one isn't diabetic. Priscilla > > There's still a lot of variation in reference ranges betwen labs. On my > > latest bloodwork, 6.3 is the top end of the reference range for [quoted text clipped - 11 lines] > who truly isn't diabetic. Just because one hasn't been diagnosed with > DM doesn't mean one isn't diabetic. Nope, my point was that the normal range still shows substantial variance between different labs. Things are much much more consistent than 25 years ago, but it is still very true that you cannot compare numbers from different labs without knowing what their normal ranges are, and the variance between labs still can be as much as a 1.0 although again it's a lot more consistent when it used to be. When I had my first A1C test done the numbers from different labs differed by 4.0! Tim. >> I think you're confusing two things. If I understand correctly, the >> "normal" range given by labs is for people at that lab who are not [quoted text clipped - 4 lines] > Nope, my point was that the normal range still shows substantial > variance between different labs. That's what Priscilla said - the value is the norm for people _at that lab_. Nicky.  SignatureA1c 10.5/5.5/<6 T2 DX 05/2004 100ug Thyroxine 95/72/72Kg >> Nope, my point was that the normal range still shows substantial >> variance between different labs. > > That's what Priscilla said - the value is the norm for people _at that > lab_. I thought the difference was due to test kit or method rather than population. Does someone here actually know for sure? bj > >> Nope, my point was that the normal range still shows substantial > >> variance between different labs. [quoted text clipped - 5 lines] > population. Does someone here actually know for sure? > bj it's based on the population average for that lab the NEW way to measure A1c is compared to the DCCT standards kate > >> Nope, my point was that the normal range still shows substantial > >> variance between different labs. [quoted text clipped - 4 lines] > I thought the difference was due to test kit or method rather than > population. Does someone here actually know for sure? My understanding is that you may get a different value at different labs due to different techniques/technologies, however the "normal" ranges differ from lab to lab due to different populations (or quality of the diagnostic work done on that population). Priscilla > My understanding is that you may get a different value at different labs > due to different techniques/technologies, however the "normal" ranges > differ from lab to lab due to different populations (or quality of the > diagnostic work done on that population). & > it's based on the population average for that lab > > the NEW way to measure A1c is compared to the DCCT > standards My question still is -- does someone know *for sure* about this or are we just arguing how we understand it?? Would my results using the same technique (& from blood taken at same time) at different labs with different populations be different or would they be the same? What population did the DCCT use to establish their standard? Do we know this? Presumably someone knows the testing techniques & other particulars they used. bj > > My understanding is that you may get a different value at different labs > > due to different techniques/technologies, however the "normal" ranges [quoted text clipped - 18 lines] > this? Presumably someone knows the testing techniques & other particulars > they used. I have a friend who's a PhD experimental psychologist with special expertise in statistics and research design. She's tried and failed to find out what the ranges given mean. They appear to be confidence intervals, but she'd like to know how they're calculated, and what proportion of a normal population would fall inside that range. Signature"and the snark alert level has reached "fuschia"" ---zig zigalo homes in on the meat of the matter > Would my results using the same technique (& from blood taken at same time) > at different labs with different populations be different or would they be > the same? Your results would be the same (allowing for any margin of error), but the "normal" range for the lab would probably be different. Priscilla >> Would my results using the same technique (& from blood taken at same >> time) [quoted text clipped - 4 lines] > Your results would be the same (allowing for any margin of error), but > the "normal" range for the lab would probably be different. Ah, but this is what we don't know! We seem to be just assuming. bj > My question still is -- does someone know *for sure* about this or are we > just arguing how we understand it?? I asked my GP once. No further evidence. Nicky. SignatureA1c 10.5/5.5/<6 T2 DX 05/2004 100ug Thyroxine 95/72/72Kg > Nope, my point was that the normal range still shows substantial > variance between different labs. Things are much much more consistent [quoted text clipped - 4 lines] > had my first A1C test done the numbers from different labs differed by > 4.0! I "compare" results from different labs by seeing "where I am" within the range, rather than just the raw number. So my 5.8 (lab ULN 5.7) would actually be worse than my 6.1 (lab ULN 6.5). bj > I "compare" results from different labs by seeing "where I am" within the > range, rather than just the raw number. So my 5.8 (lab ULN 5.7) would > actually be worse than my 6.1 (lab ULN 6.5). That is the method my docs at research hospitals have always used to compare. I have 20-some years and 10 different labs and most of a hundred different numbers worth of A1C for comparison :-). Tim. >> There's still a lot of variation in reference ranges betwen labs. On my >> latest bloodwork, 6.3 is the top end of the reference range for [quoted text clipped - 5 lines] >> The variation is much much less than when I first got a newfangled A1C >> tests at a research hospital a quarter century ago! > I think you're confusing two things. If I understand correctly, the > "normal" range given by labs is for people at that lab who are not > diagnosed with DM. That's very different from what's an A1c for someone > who truly isn't diabetic. Just because one hasn't been diagnosed with > DM doesn't mean one isn't diabetic. And given how much "diabetic" damage like peripheral neuropathy, atherosclerosis, retinopathy, etc., can occur at pre-diagnostic but higher-than-normal BGs, it doesn't make much sense to worry about whether strictly speaking you're not (yet) diabetic and can relax, or really are diabetic and ought to do something about it. If your BG control is approaching diagnostic levels you're already on the slippery slope of a progressive disorder, and the sooner you apply the brakes the less it's going to progress. Applying the brakes simply means behaving like a good diabetic ought to. The difference between being diabetic and being not quite or not yet diabetic is simply how steep the slope is that you're already sliding down. It's easier to stop sliding down when the slope is shallower. SignatureChris Malcolm cam@infirmatics.ed.ac.uk DoD #205 IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK [http://www.dai.ed.ac.uk/homes/cam/] > >> There's still a lot of variation in reference ranges betwen labs. On my > >> latest bloodwork, 6.3 is the top end of the reference range for [quoted text clipped - 25 lines] > diabetic is simply how steep the slope is that you're already sliding > down. It's easier to stop sliding down when the slope is shallower. Exactly. Priscilla >Your home-grown data doesn't seem to fit any of his curves. However, the >"standard" curves assume some sort of standard stomach emptying behavior >which turns out to be affected by the amount of fluid you take with the 75 >gram of glucose. More fluid = faster bG rise, e.g. Hmmm.. I was told it was OK to drink water before the test and I asked if I could drink while waiting. I probably drank about 10oz (300ml) in the hour leading up to the test and at least that much about 30 minutes prior to the 2hr measurement. Reading the article would imply that diluting the glucose affects the release from the stomach which in turn affects the test at most points. While that might explain why my levels continued to rise over a period, I was still too high even three hours later. BTW - at 5 hours (after my first message), I fell lower than I'd ever gone before - 56mg/dl (3.1 mmol/l). Felt weak and got the shakes. I've never tested below the low 80s before. I understand the mechanics and also understand this is one of the more dangerous aspects of Diabetes. It's just never happened to me before. Of course, I'd never been above the 140s either until I drank the glucose. I'd even tried to sugar load for some of my tests. BTW - I'm still in my "do nothing" stage. I told my physician that I would initially track my BG while eating and (not) exercising the way I had always done so. I did this for 1 month to come up with the numbers previously reported. I would then take the OGTT (today) and then the next phase would employ exercise and diet change to see how things changed. So these numbers are natural and not affected by medication, diet or excercise. I've had many T2s tell me their numbers are better than mine but they're where I'm heading already. After my bad results today, I guess I'm even more motivated for the next phase. Thanks for the comments and the info. This is my favorite of all DM related sites. > BTW - I'm still in my "do nothing" stage. I told my physician that I would > initially track my BG while eating and (not) exercising the way I had [quoted text clipped - 10 lines] > the > next phase. I'm very glad you're planning on further action - your numbers look unambiguously diabetic to me. If I'm at 130 at the two hour mark, I'm on my air walker trying to sweat it off! I will also have been much higher at the 1-hour mark - if I were you, I'd be testing foods to find out where your personal peak occurs, and work on reducing that. Nicky. SignatureA1c 10.5/5.5/<6 T2 DX 05/2004 100ug Thyroxine 95/72/72Kg > After 1 month of self testing (about 100 total pricks), I had a single high > reading of 149, two of 139 and the remainder never cracking 130. These were > all 2hr post meal tests. My average was 111. Of the fasting readings, my > highest was 119 and my average was 109. > > Based on this, I felt pretty confident that I fell into the IFG category. Actually, your home tests suggested you might have both impaired glucose tolerance (IGT) as well as IFG. > Imagine my surprise when my 2 hr GTT was 212! I realize I drank 75g of > glucose but never imagined I would go that high. Odd thing is that this was a > rise over the 1 hr level (205). These are unofficial tests with my meter - I > won't have lab results for 2 days. I tested again in the car at 2hr and 15 > minutes and the level had risen to 229. At 3 hrs, it had fallen back to 200. This is not surprising at all given the probability of IFG and IGT based on the results of home testing. > In addition to being surprised and dismayed, I'm also confused. Is there > anything that can be read into the fact that my BG didn't just remain > elevated, it rose? Could this have a metabolic component to it? Last week, my > hA1c was 6.3. That, along with my own finger pricks suggested to me that my > day to day levels were just entering the impaired range. There are two phases to insulin release. In 'normal' folks, Phase 1 insulin response releases a large amount of stored-up insulin granules. This large release causes glucose to be utilized by cells for energy and for excess glucose to be stored. Phase 2 insulin response occurs shortly thereafter. Phase 2 is the body producing and releasing insulin as fast as it can be generated until glucose levels return to the pre-meal state. Folks who have developed insulin resistance and are experiencing IFG and IGT tend to have a deteriorating Phase 1 insulin response. That means the pancreas squirts out fewer granules, and/or the quality of the granules isn't as good thus less effective, and/or insulin resistance has programmed cells not to burn or store glucose. So Phase 1 release in IFG/IGT/IR folks does the best it can, but it may cause a BG spike, and it may not be sufficient to bring glucose back to pre-meal levels. So Phase 2 takes over, generating and releasing insulin as fast as it can. However, it may not be fast enough, which is why folks see an additional rise in BG until enough insulin is produced to use/store the remaining glucose. Phase 2 response can take several hours. |
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