Thursday, April 7, 2011

Diabetes? Type 1, Type 2, or [Type] None?

Last night, I received a phone call from my MD at home.  The results of my fasting glucose and insulin tests from last Friday came in.  My fasting blood glucose was 118 mg/dl, and my fasting insulin was 10.  Apparently, the blood glucose was elevated, but the insulin was well within the normal range (the max normal is 17).  The fasting blood glucose result seemed strange in light of the prior post-prandial glucose test I took at the lab, which resulted in a reading of 95 mg/dl.

But...I expected a higher than normal fasting blood glucose.  I have read a number of blog entries and posts from low-carbers out there who have had the same results:

My doctor is concerned that I may be diabetic.  According to her, I should do a glucose tolerance test, and get my HbA1c tested.  I told her that I was worried about getting a false positive from a GTT because of my low carb diet.  As observed by Dr. Atkins: 

"Note: The GTT results are not considered accurate unless you are consuming at least 150 grams of carbs a day for at least four days before you take the test. Therefore, doing it after you start Atkins would mean you'd have to go back temporarily to eating a high carbohydrate diet (and almost certainly regain some of the pounds you have just successfully lost)."  Dr. Atkins New Diet Revolution, p.113 (2002 ed.). 

This recommendation seems to be pretty mainstream:

"Those taking the OGTT to diagnose diabetes or prediabetes who are not pregnant should eat a normal, balanced diet the week before taking the test. Experts recommend that this diet include at least 150 to 200 grams of carbohydrates per day. Patients must fast for at least 8 to 12 hours before having the test."; see also, (recommending 150g for 3 days prior to GTT).

I know I'm getting about 20-30 grams of carbs a day, which is confirmed by my carb counting and daily ketosis testing.  I'm leery about guzzling all of that sugary stuff for the GTT, about high-carbing it for 3-4 days prior, and about sticking around a blood lab for 2 hours to get the GTT done (I have to work, people)!! 

So, we're compromising.  I'm going to do another fasting glucose and the HbA1c tomorrow morning before work.  I'm going to start monitoring my blood sugars three times per day with a home glucometer, which I have to pick up this afternoon from the pharmacy (yay, insurance paid for the glucometer and lancets – no copay!).  Then we'll see if we need to do the GTT after those results come in.  Hopefully, the HbA1c will look good enough so that I don't have to do the GTT.

I have read that exercising at night, and eating a good, low carb snack before bed, can help with fasting blood glucose.  Guess that means that yours truly is hittin' the gym tonight.

I hope I'm not diabetic.  Type 1 and Type 2 are both in my family.  Type 2 I can deal with, as it is likely to resolve itself once I've got my health and weight under control.  Type 1 is pretty scary stuff. Shudder.  My maternal grandfather and first cousin once removed have Type 1.  But I make insulin…  and I have PCOS, which is related to insulin resistance (I make too much insulin).  I don't know how you can have symptoms of insulin resistance and have Type 1 diabetes, because having insulin resistance implies that you are producing a lot of insulin and your cells just aren't responding to it.

I'm going to start keeping track of my blood glucose levels on this blog.  Hopefully, it will provide some insight and result in a healthier me.

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