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What does this glucose tolerance test report indicate?

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Posted on Wed, 13 May 2015
Question: HI. Starting (3) years ago I started experiencing dizziness, unsteadiness, and light fatigue after eating high complex carb meal or simple sugars. (1) year ago, the symptoms progressed. 5 minutes to 40 minutes after a meal, I feel the above symptoms with confusion and extreme fatigue. Sometimes with palpitations and SOB. Cold intolerance in the hands. This may happen with even just one cracker within 5 minutes. I have eliminated most complex carbs and all simple sugars with some improvement. Another major symptom is exercise intolerance. I am unable to left or even ride a bike for 5 minutes without feeling extremely fatigued and very SOB. Other symptoms: dizziness when going from sitting to standing (more prevalent after eating) and chest congestion for about 30 minutes after eating. Blood pressure taken at lowest 92/68 after eating. History of milk protein allergy and chronic IC. NO milk in diet. Restricted salt in diet for last 6 years and no IC symptoms. Depo Provera injections for 12yrs. Last shot April 2014. Tests:
Food Allergy tests negative
Abd CT negative (pelvic cyst noted)
CT chest negative
IGF-1 4/17/15: 200
Prolactin 4/17:15: 12.3
T4 Total 9/7/12: 8.8 10/14/13: 7.8 3/31/14: 6.5 4/17/15: 5.2
ACTH 4/08/15: 16
Cortisol: 4/8/15 taken at 11:04am: 9.5
Fasting Glucose 4/8/15: 87
TSH: 9/7/12: 1.36 10/14/13: .71 3/31/14: 1.13 7/7/14: 1.13 10/29/14: 1.31 4/17/15: 1.69
10/29/15:
Glucose 65 - 105 mg/dl 88
Sodium 135 - 144 mmol/L 139
Potassium 3.6 - 5.1 mmol/L 4
Chloride 98 - 108 mmol/L 108
CO2 22 - 32 mmol/L 26
BUN 7 - 17 mg/dl 18
Creatinine 0.6 - 1.1 mg/dl 0.6
Anion Gap 7 - 16 mmol/L 9
Protein total 6.1 - 7.9 g/dl 7
Albumin 3.5 - 5.0 g/dl 4.4
Globulin, Total 2.4 - 4.2 g/dl 2.6
A/G Ratio 1.1 - 2.2 1.7
Calcium 8.4 - 10.3 mg/dl 9.3
Alkaline Phosphatase 25 - 120 U/L 64
AST 14 - 36 U/L 20
ALT 14 - 54 U/L 25
Bilirubin Total 0.4 - 2.0 mg/dl 1
GFR XXXXXXX XXXXXXX 59 RATE >60
GFR MDRD Non Af Amer 59 RATE >60
WBC 4.3 - 11.0 K/CU MM 4.9
RBC 3.94 - 5.42 MIL/CU M 4.31
Hemoglobin 11.5 - 16.0 g/dL 13.9
Hematocrit Order Analyte 34.5 - 48.0 % 40
MCV 77 - 102 CU MICR 93
MCH 27.0 - 32.0 PICO G. 32.2
MCHC 32.0 - 36.5 g/dl 34.7
RDW 11.5 - 14.5 % 12.2
Platelets 150 - 425 K/CU MM 157
MPV 6.8 - 10.6 CU MICR 11.2
Neutrophils Relative 40.0 - 80.0 % 57.7
Lymphocytes Relative 10.0 - 47.0 % 30.9
Monocytes Relative 2.0 - 11.0 % 8
Eosinophils Relative 0.7 - 7.8 % 3.2
Basophils Relative 0.2 - 1.1 % 0.2
Neutrophils Absolute 1.9 - 7.2 TH/uL 2.8
Lymphocytes Absolute 1.1 - 2.7 TH/uL 1.5
Monocytes Absolute 0.3 - 0.8 TH/uL 0.4
Eosinophils Absolute 0.0 - 0.5 TH/uL 0.2
Basophils Absolute 0.0 - 0.1 TH/uL 0
Transferrin 192 - 382 mg/dl 202
Ferritin 11 - 307 ng/ml 63
Lipase 8 - 57 U/L 20
Amylase 36 - 128 U/L 37
8/22/14:
Glutamic Acid Decarboxylase AB 0.0 - 1.5 U/mL <1.0
Insulin, Fasting 2.6 - 24.9 uIU/mL 13.5
C-Peptide 1.1 - 4.4 ng/mL 2.6
Insulin Antibodies <5.0
This test is also known as insulin autoantibody or IAA.
Reference Range:
<5.0 Negative
> or = 5.0 Positive
Hemoglobin A1C 4.0 - 6.0 % 5
7/14:
GTT: sugars at 222 at 2 hours mark, insulin at 32. (retook two months later- sugars normal but no insulin level done). Endo believed high sugars due to restrictive carb diet. Introduced some carbs into diet before re-doing test. Took metformin for one week. Was able to tolerate more carb/sugar foods without dizziness but still extremely fatigued with 30 minutes. Recently tried Metformin again, and felt weaker, more fatigued.
ECHO negative
EKG: negative
PFT: possible restrictive lung dz, suggests parenchymal lung dz but ruled out by pulm doc after chest xray and examine
10/14/13:
Vitamin B-12 180.0 - 914.0 154 (started b12 shots monthly)
*On no meds currently.
Any idea of a diagnosis?
doctor
Answered by Dr. Binu Parameswaran Pillai (39 minutes later)
Brief Answer:
Few possibilities

Detailed Answer:
Good day,
Noted your concern . Noted the investigations as well. Investigatons are normal except the Glucose tolerence test on one occasion. I can think about few differentials.

1) Reactive hypoglycemia / Idiopathic postprandialsyndrome
2) Insulinoma
3) ??? Carcinoid syndrome
4) Axiety

You may need to do an extended GTT ( 5 hours ) following a mixed meal or a heavy carbohydrate meal. You may also need to do a 72 hour fasting hypoglycemia evaluation. Besides, to rule out carcinoid syndrome, you will need a 24 hour urine 5 HIAA test ( need diet modification prior to test) and blood CHROMOGRANIN-A levels. Other test to consider is an Insuli receptor antibody test.

You will have to discuss with your endocrinologst about these special tests

Regards
Binu


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1435 Questions

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What does this glucose tolerance test report indicate?

Brief Answer: Few possibilities Detailed Answer: Good day, Noted your concern . Noted the investigations as well. Investigatons are normal except the Glucose tolerence test on one occasion. I can think about few differentials. 1) Reactive hypoglycemia / Idiopathic postprandialsyndrome 2) Insulinoma 3) ??? Carcinoid syndrome 4) Axiety You may need to do an extended GTT ( 5 hours ) following a mixed meal or a heavy carbohydrate meal. You may also need to do a 72 hour fasting hypoglycemia evaluation. Besides, to rule out carcinoid syndrome, you will need a 24 hour urine 5 HIAA test ( need diet modification prior to test) and blood CHROMOGRANIN-A levels. Other test to consider is an Insuli receptor antibody test. You will have to discuss with your endocrinologst about these special tests Regards Binu