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Glucose tolerance test done. Feeling sick. Diagnosed with reactive hypoglycemia. Chances of diabetes?

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Practicing since : 2001
Answered : 1490 Questions
Hi. I was rediagnosed last July with Insulin Resistance, I've been frightened, frustrated and quite alone with this and I really need advice. I've just had my third glucose tolerance test yesterday morning and I was shocked to see how dramatic the figures have become:

Fasting level - 6.3
plus 1/2 hour - 15.2
plus 1/2 hour 17.1
plus 1/2 hour - 15.4
plus 1/2 hour - 5.4

I am still feeling sick and weak after it. On the last test (my second one) the final level was 2.4 and I was also diagnosed as having reactive hypoglycaemia. I am very concerned about the levels from yesterday but my next appointment with my endocrinologist isn't scheduled until October although the phlebotomist said that she would probably call me on receipt of them. But in the meantime and because I'm worried, could you tell me if this looks like a diabetic pattern? I'm doing everything I can in terms of diet to control blood glucose levels and I’m, only 9st 1/2lb (I'm 5'7.5") and lost a further 4lbs without trying this last month. I'm feeling fairly desperate about this as I can't seem to control anything.

Just to say I'm taking 2500g metformin per day. It was 2 tablets after breakfast, 1 after lunch and two after dinner but my doc changed it last week as my highest levels of the day were occurring in the morning so she changed it to 3 tablets after breakfast, 1 after lunch and 1 after dinner.

What is really bothering me is that I can't seem to control the rise and fall of the blood glucose. This wave pattern, I know, is characteristic of Insulin Resistance but even with strictly controlling my diet and metformin and exercise, it has just started going crazy. My eye sight has worsened in the past few months. I am constantly tired, my head won't work, I have no concentration, am prone to terrible short term forgetfulness and if I try to exert myself even around the home, its as if a plug has been pulled, all power leaves me and my blood sugar levels drop like a stone.

There is though a pattern within the absence of pattern in that my blood sugar will rise at the drop of a hat in the morning while I can withstand challenges (in the form of food!) later in the day particularly the evening. To give an example - this morning I ate 2 tbls yogurt, 1 dsp chopped nuts and half a grated XXXXXXX mixed together with a half slice wholemeal toast and a cup of coffee. Before breakfast my level was 5.7 but afterwards it XXXXXXX (half an hour later) to 11.4. Curiously, I had chicken stirfry (my own!) last night for dinner. My level before was 6.1 but after my much larger meal it XXXXXXX only to 7.8!

Is this now diabetes?
Posted Mon, 27 Aug 2012 in Thyroid Problem and Hormonal Problems
Follow-up: Glucose tolerance test done. Feeling sick. Diagnosed with reactive hypoglycemia. Chances of diabetes? 1 hour later
Hi, further to the above which I wrote two weeks ago before submission, I have had a letter from my endocrinologist. The above blood glucose levels were read off for me by the phlebotomist as she was drawing the blood. She said that the lab results would be more accurate. The endocrinologist gave me the lab results in her letter - 4.6/12.7/15.1/14.1/6.1. She says that this is not a diagnosis of diabetes and has asked me to keep a diary of blood levels and food at home and have a HbA1c and fasting glucose tests before seeing her again at the end of August. At the end of my meeting with her in mid-July, she mentioned that other hormones could be at work in the morning and mentioned growth hormone in particular but didn't elaborate. Last summer, she checked cortisol for Addisons which was fine, last Autumn she checked (I think) for cushings which was clear. I'm at my wits' end now and the end of August seems very far away.Could growth hormone be responsible for my utter lack of energy and this perisistent insulin Resistance? Certainly, the metformin is having little effect on it and there's no where else to go in terms of diet - I eat more restrictively and carefully than diabetics. Please help. Thanks
Follow-up: Glucose tolerance test done. Feeling sick. Diagnosed with reactive hypoglycemia. Chances of diabetes? 7 minutes later
Sorry to keep coming back but another thing occurred to me - if growth hormone deficiency is responsible for the insulin resistance, could that be the reason the metformin is ineffective in the morning? Thanks
Answered by Dr. Shehzad Topiwala 29 hours later
The endocrinologist you saw has given you sound advice. Do not try to fully understand how hormones work because even we do not know exactly everything about hormones. They are complex chemical substances in the body that do several things, some of which we physicians and scientists understand and there are other things that we either dont know fully well or little about. So do not get anxious about growth hormone, cortisol etc. Let your endocrinologist guide you as to what is worrisome and what is not.
So far, all you need to do is exercise with prudence after checking with your physio or GP as to how much graded exercise is safe for you. Secondly, dietary discretion is key. Weight loss is the ideal goal.
Growth hormone surges can cause a resistance to the effect of insulin in the early hours of the morning. But there is nothing you can do about this. If your endocrinologist suspects you have growth hormone excess, then he or she will consider ordering a blood test called IGF1 to screen for it. Ruling out an underactive thyroid would be a good idea by doing a simple test called TSH
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