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Suggest treatment for rapid weight loss due to impaired glucose tolerance

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Posted on Fri, 7 Oct 2016
Question: An endocrinology question

I am 52 years old and have some indications of being 'glucose impaired. Last FBG was 6.3 mmol (~115 mg/dl).
I have started a rapid weight loss program now to try and rid myself of visceral fat deposits and diffuse fatty infiltrations in my liver in the hope I can turn this around or at least delay a progression to T2 diabetes. I am quite contented with my progress as I have lost about 8% bodyweight and counting in the last month.

That aside, I have been testing with a glucometer and found something interesting. I take a reading at wakeup after 10 hrs of fasting and see a number of between 4.3 and 5 (76 and 90 mg/dl) . I go and have a shower , maybe put on some laundry and take a sample again at 60 minutes before my first meal of the day and it's between 6 and 7 mmol (106 and 126 mg/dl) . Sometimes if I delay breakfast and wait another hour it will drop below 6mmol. My 2hr post prandials more often that not are 4.4 to 5.5 (80 and 100 mg/dl) depending on the meal.

I'm working on the premise that I already have some level glucose metabolism impairment but what I am curious about is this sudden jump in blood glucose after that first normal read of the day? Is that something that happens to normal people or am I dumping liver glucose with a poor pancreatic response or does a normal person have this a glucose excretion but the pancreas responds more keenly?

It takes me an hour to shower dress and get to the local pathology collection centre so just curious if this is skewing my blood work?. ..thanks
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Answered by Dr. Shehzad Topiwala (57 minutes later)
Brief Answer:
Glucose

Detailed Answer:
Hormones are too complex too fully understand easily and explain blood levels of things they control. In your case it is insulin and glucagon and even others like growth hormone , catecholamines and cortisol that impact your blood glucose levels. This mechanism operates every moment in our bodies and regulates blood glucose through effects on various organ systems such as the liver. I must say you have a fair understanding of the subject while most people do not comprehend this well at all. However no one can exactly indicate why each of those blood glucose levels appear the way they do in your case. For one, the glucose monitor you use has certain limitations. It can give you a 10-20% variation on either side of the true reading. So no precise scientific conclusions can be drawn from the numbers you record on the glucometer. I see your nearest laboratory is not close but that is the most accurate glucose value. I have noted that this too shows variability. Multiple activities determine the blood glucose level such as being up and about. Yes the liver pours excessive glucose into the blood particularly in the morning , in those with diabetes. This is also in the response to the 'counter regulatory ' hormone surge in the morning hours. These include cortisol and growth hormone. When I see patients like you, I advise them against checking glucoses at home or at the lab , and instead check HbA1c every 6 months or so. This is a blood test that gives you the average blood glucose in the preceding 3 months.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Suggest treatment for rapid weight loss due to impaired glucose tolerance

Brief Answer: Glucose Detailed Answer: Hormones are too complex too fully understand easily and explain blood levels of things they control. In your case it is insulin and glucagon and even others like growth hormone , catecholamines and cortisol that impact your blood glucose levels. This mechanism operates every moment in our bodies and regulates blood glucose through effects on various organ systems such as the liver. I must say you have a fair understanding of the subject while most people do not comprehend this well at all. However no one can exactly indicate why each of those blood glucose levels appear the way they do in your case. For one, the glucose monitor you use has certain limitations. It can give you a 10-20% variation on either side of the true reading. So no precise scientific conclusions can be drawn from the numbers you record on the glucometer. I see your nearest laboratory is not close but that is the most accurate glucose value. I have noted that this too shows variability. Multiple activities determine the blood glucose level such as being up and about. Yes the liver pours excessive glucose into the blood particularly in the morning , in those with diabetes. This is also in the response to the 'counter regulatory ' hormone surge in the morning hours. These include cortisol and growth hormone. When I see patients like you, I advise them against checking glucoses at home or at the lab , and instead check HbA1c every 6 months or so. This is a blood test that gives you the average blood glucose in the preceding 3 months.