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Discordance between A1C and oral glucose tolerance test results


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Well if i did not throw me for another loop. Took a A1C test and it came back normal (5.6) but my OGTT was abnormal 308 and 311 at the 2nd hour mark. Also my finger sticks show a diabetic level after eating. Not sure if other folks have seen this? all i can think is i fast quite often (to a fault) and have not been able to stick with the 6 small meals a day (always revert back)

I did read somewhere that intermittent fasting will affect the A1C results. I am frustrated. i can see a bit of a battle coming down the road with my providers.

Not sure if this is common with dysautonomia.

 

 

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@MikeO -- I have no clue, but I was thinking about your situation the other day and was wondering if your A1c was normal or elevated. To me, if your A1c is normal, then your body is responding to insulin correctly. You wouldn't have normal A1c levels if you were insulin resistant. I can't imagine how a normal A1c coexists with insulin resistance.

I have been taking a potassium supplement for the last couple of weeks and this seems to have made the biggest impact on my PVCsl burden -- more than any other thing I've tried. They are nearly gone and I only feel a handful a day instead of thousands a day.

So, I've been reading up on potassium physiology (which gets me back to your situation) and did you know that insulin stimulates potassium to shift into our cells, lowering the plasma levels? I think it does this with the anticipation that the potassium we absorb from food will replace this deficit -- like it occurs to prevent hyperkalemia. Additionally, low potassium can cause low blood pressure. Do you think this could be why you get symptomatic after eating? Maybe your body is actually quite sensitive to insulin?

I'm beginning to suspect that this intracellular shift in potassium is why my heart races sometimes after eating, particularly when I eat a carb or sugar heavy meal. I'm thinking the extra insulin temporarily lowers my potassium causing tachycardia and palpitations. Could you try a potassium supplement (maybe with magnesium) before a meal to see if this helps?

 

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@JennKayI am so Happy to read your progress with the PVC's "Good News". I did look at my past potassium levels and i do have room to bring it up but my sodium levels tend to hang out on the low side (136-138) not sure if the additional uptake of potassium would cause my kidneys to dump more sodium?

The A1c thing certainly short circuited my brain and my PCP's response to the good number (looks like the metformin is working) did not help. Haha little does he know i never started taking it :)

I can say my food testing (lots of finger pricks) does show that my BG significantly spikes with simple carbs and refined carbs which i very rarely eat or drink anymore (at least for a year now). I sure the A1c does reflect the better diet to some degree. Only other thing i can think of is that my Red Blood cells are dying a bit too quick. My previous CBC's does show that my RBC is always right at the edge of the normal high side.  

I did reach out to an organization out in San Diego "https://tcoyd.org/" Below is what they came back with. I am sure we caught the diabetes at the early stage.

"There’s good news to your results. You do bounce up high after eating simple carbs, so please do not do any more glucose tolerance tests. It shows you that eating well-balanced meals does not cause a spike. The fact that your A1c is good shows that overall, you’re doing really well. Intermittent fasting does not affect your A1c. A1c is the result of the duration and severity of hyperglycemia over the past 2-3 months. In addition, for people who are diagnosed early with type 2, they can get low after eating acute carbohydrates, which is totally normal."

   

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@MikeO -- I see. Well, if this happens in pre-diabetics then I guess it jives with your experience. I still think it is weird that your A1c is normal. Couldn't all of this also suggest that your is producing lower amounts of insulin (maybe b/c of age?) but that you are still responsive to that insulin? But, I'm not a diabetes expert and literally have no experience with this, so I really have no clue! :)

@Pistol -- I agree! I was surprised and reassured when I read in a review that insulin lowers plasma potassium levels. I thought of all the people on here that struggle with tachycardia and palpitations after eating, including myself, and thought there may be a correlation. I also find it interesting that many people on here post that they feel better when eating a more restrictive, low-glycemic index/paleo style diet. I know that any change to our systems (like eating) can cause issues, but I wonder how many of us are dealing with subclinical electrolyte imbalances -- like at levels that doctors wouldn't treat. My potassium levels run in the low 4s, but after starting the potassium supplement my palpitations have nearly disappeared and my GI symptoms are gone. I've been dealing with both for 1.5 years non-stop. I wish I would have been advised to try potassium sooner.

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14 minutes ago, JennKay said:

I still think it is weird that your A1c is normal. Couldn't all of this also suggest that your is producing lower amounts of insulin (maybe b/c of age?) but that you are still responsive to that insulin? But, I'm not a diabetes expert and literally have no experience with this, so I really have no clue! :)

I am so with you as to being clueless. I would think the A1c would have been higher seeing that when i eat my BG can or will be in the diabetic range. 229 for three + hrs from eating just three ground beef enchiladas and refried beans. For now i think the best i can do for myself is to keep my time in range good and Glucose variability managed well. 

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@JennKayI just wonder if slow gastric emptying and fast gastric emptying has a effect on my glucose levels. Last night i ate a good half of pizza and never really felt full and in fact my stomach actually started grumbling (does not happen often). My BG levels did not change more than 15 points even 5 hrs later But on Sunday i ate 3 enchiladas my BG hung out in the 200's for a number of hrs and i still felt full the next day so i fasted till dinner. Just a thought.

https://pubmed.ncbi.nlm.nih.gov/23663508/

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@MikeOI have had some personal experience with some of this.  I have type 2 diabetes and I am now on Metformin.  It has helped my A1C, bringing me down from a 7.8 to a 7.1.  But for years before my A1C showed a higher range, I had issues processing food and insulin.  I would go from very high numbers an hour or two after eating and then I would drop suddenly to very low ranges (300-400 down to 60-70)  It was truly awful. But my A1C remained low. The endocrinologist explained it to me quite simply by calling it a "lazy pancreas"  He said that when I eat my levels climb and climb, and my pancreas just sits around doing nothing much.  Then it wakes up and releases a boat load of insulin into my system causing me to crash.  As I said, it was the least medical diagnosis I have ever received.  I was only in my 20s at the time so I really didn't question it.  I also should mention that this began following a severe car accident that bruised my pancreas and caused me to have pancreatitis for over a year.  In my case, they treated my pancreas instead of the sugar level symptoms.  They also put me on a diabetic diet which I did adhere to strictly for many years.  I am now in my early 60s and given my age and the history, I'm not surprised to learn I have Type II.  

I believe that one of the best things I have done for myself over the years is maintaining a healthy Mediterranean diet and eating smaller portions more frequently.  I credit my diet and activity level with keeping full blown diabetes away for so long.  I mention activity because it is also one of the best gifts I have given myself.  Like most people living with dysautonomia, I am exercise intolerant, so I don't say this lightly, movement has been critical for me.  Some days/weeks, movement might be limited to lifting my arms in the air for 5 reps each and other times I take walks and garden and am more active than most of my healthy friends my age.  But movement of some sort helps me tremendously in controlling diabetes as well as so many other symptoms related to dysautonomia.  

I've been told by many doctors over the years that fasting is a no-no for diabetes.  The 6 meals a day thing is tough to get used to but like everything else we do, it's worth it if it helps us be less symptomatic.  I hope you can find the right combo of things to help your symptoms.

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@MikeO -- That article is interesting! I still have no clue, but it seems plausible. I bet there are a number of different things going on, which is super frustrating b/c all the variables keep changing. That is how I feel about my symptoms most of the time anyway 😆

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On 1/12/2023 at 10:20 AM, edriscoll said:

I also should mention that this began following a severe car accident that bruised my pancreas and caused me to have pancreatitis for over a year. 

Funny you mentioned this. Looking back i have been passing out since middle school and as i recall i did have an injury to my abdomen. Like most boy's i hid it. I would even pass out while eating. To this day still happens from time to time. I have also been in two severe car accidents no sure how this plays out with me. I am being optimistic that a dietitian can help but i am a bit put off by the generalized responses from the docs. Being orthostatic is not a disease it's just a symptom of some other issue. I swear nurses in the trenches know better.

Again thanks for your insight.

Mike    

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My glucose levels are not as high as yours, but I had a similar issue! My A1C was normal, but I was getting weird glucose spikes and my fasting was high in the morning no matter what I ate or did. I guess maybe it shows that single test's limitation?? I wouldn't be surprised if it is dysautonomia related.

After seeing your glucose threads, I bought some more glucose strips to test. For some reason my glucose levels have been good again on their own. I haven't done anything differently except change the beta blocker I was on. Not sure if related. Instead of acebutolol, I'm now on nebivolol (bystolic).

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Hi @Birdlady I am happy to have a good A1c for now. Tells me i am doing something right. I know i have had BG issues in the past (more hypoglycemic) by symptoms (i think) and this is what got me the OGTT in the first place. Again i fast more than i eat. While i do not have much past data to share i did become sick not too long ago and stopped my Pyridostigmine. I was very orthostatic and symptomatic. 

I did have a CGM put on (December 15th) it showed hypo right of the bat (low was 40) so that did motivate me to change my diet. What i did not due was to rechallenge on Pyridostigmine until this last Monday and noticed my BG normalized. I have also started fasting again.

I am sure i can test some of this out and stop the Pyridostigmine to take this out of the mix and retry eating a normal diet and see what i get.

I am sure i will post again

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Well back to my original have no idea why my BG can be good for a number days and then not. I am sure the Mestintion has nothing to do with it as i took the med today.

Below was from eating a fish sandwich.

551970837_MondayDiabetesAnalytics.jpg.7b0e313b449c640a47bc6f47dc3dc196.jpg

 

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Well one more update. I did stop my pyridostigmine on Tuesday and started the Metformin sure it will take a bit too see if this goes bad or i can tolerate the drug. Today i do see some changes. I did have a 1 hr spike in BG (185 with 30 carbs) then at hr 2 came down to 109. Just tested again and i am at 86. I just hope this does not increase my Hypo.

I also did see a dietician Thursday. All I can say is sometimes you win some or lose some. I can't see eating some of the foods layed out in their brochures i already know better by experience. May just be another example of generalized medicine. 

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Well last update i will do (maybe). Been messaging my Doc in regards to a normal A1c and my BG excursions being high his response was "He has not seen this in his 10 years of practice" I am sure he will not be doing any more diagnostics at this point.

I do see him in March so i'm sure i will be discussing this.

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  • MomtoGiuliana changed the title to Discordance between A1C and oral glucose tolerance test results

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