Blood glucose tests help

I'm 29 years old, male and just received the following 2 blood tests:

Fasting glucose 80
HBA1C 7.0%
Fructosamine 0.8mmol/l (ranges 1.50-2.70)

Does the low fructosamine value means that I could be suffering from hypoglycemia?

Does the HBA1C is within range?

I'm currently taking Elavil and don't know if this drug can affect the values from the blood tests.

Help is greatly appreciated.

[JDRF-Team-sgg]

The following web site offers a good explanation in layman's terms of the tests and what they show:
http://www.diabetesmonitor.com/ghb.htm

It appears that you may have been slightly hypoglycemic for the past 3 weeks, the period of time tested by the fructosamine test. However, your a1c level is slightly higher than the ideal, although still not "bad." Most endocrinologists nowadays like to see a1c levels close to 6 or even in the upper 5's, but generally are happy if the a1c number is under 7. Your number at exactly 7 is on the upper range of the usual goal. So it appears that your recent (last 3 weeks) glucose levels have been lower than they perhaps were at the beginning of the time that the a1c tests for (about 2-3 months ago). Your fasting number is perfect. If you are not finding hypoglycemia when you do your glucose tests, I would not worry about lows, for they will show up in routine glucose tests if you test several times a day.

As for the possibility that the drug Elavil may be affecting your blood sugar levels, read the side effects listed on this web site:
http://www.healthsquare.com/newrx/ELA1155.htm

It appears that this drug CAN cause glucose levels to go high or low. You may want to discuss this with your doctor, especially if you notice changes in how your glucose tests  read since you began taking this medication. I would advise you to perhaps do more frequent glucose tests than usual (perhaps every 3 hours or so), write down the readings and then if you notice abnormalities, call your doctor and discuss this with him or her. There may be a drug other than Elavil that will treat your symptoms just as well without affecting your glucose levels if this indeed is happening to you.

[Pat M.]

Well, since your HBA1C is perfectly normal, I'd say you probably aren't suffering from hypoglycemia.

Do you have any symptoms? Shakiness, weakness, hungeer, loss of concentration, etc?

[JDRF Team SGG]

I posted the answer originally and now am wondering if you are perhaps NOT a diabetic at all, but perhaps have come to this web site seeking to find out what the normal ranges of glucose are. Your question about hypoglycemia leads me to wonder if you have a glucometer at all. If not, then you cannot check for hypoglycemia yourself, so your questions are smart ones. I do apologize if I misunderstoon originally and thought that I was answering a diabetic who was taking the medication Elavil.

The range of glucose levels that are considered "normal" are between 70-126 (give or take a few numbers, for doctors differ slightly on the ideal range). People who are neither diabetic nor hypoglycemic do find it normal for gluocse values to vary throughought the day as the body responds to the foods you eat. Most diabetics start to feel bad when glucose is dropping and begins to approach the 70 mark, so numbers below that are considered hypoglycemic. Below this number, your ability to think clearly, react quickly to stimuli of any sort, and function without fatique are impaired. So yes, you may be hypoglycemic. Your Glucose Tolerance Test shows that your body does respond to the high glucose in the syrup you drank by over-producing insulin at times. However, this test seems to show that your body works normally to level off the glucose levels when they do drop.

Some of your symptoms do sound perhaps like hypoglycemia, but this is a hard diagnosis for a doctor to make since he can only get readings from the GTT and has no way to see how you react in normal daily life to normal food and activity. You may find that it is wise to ask him about possible side effects of the Elavil and possibly to go to a diet that avoids caffeine and high-glucose foods that may trigger reactions if you tend to be a reactive hypoglycemic. An experiment with this kind of diet may be helpful to you and you can see if your energy levels return. You could also try treating fatigue with small amounts of juice (1/2 cup) and protein such as nuts or cheese to see if you feel better in about a half hour after nibbling when you feel fatigued. I am not a doctor, by the way, but am a type 1 diabetic of many years who has lots of relatives and friends who deal wtih hypoglycemia, so I have done lots of reading on the subject.

[robertin75]

Thanks for your comments. I do suffer from lack of energy, lack of concentration and fatigue.

I also had a GTT (glucose tolerance test) with the following results:

basal glucose  92 mg/dl (ranges 65-110)
30 min         52 mg/dl (ranges 110-170)  OUT OF RANGE
60 min         82 mg/dl (ranges <140)
120 min        63 mg/dl (ranges 70-120)   OUT OF RANGE
180 min        101 mg/dl (no reference range)

It would be great if someone could give me their feedback regarding these GTT results.

Also, does the low fructosamine value doesn't mean that I could have hypoglycemia?

Thanks

[robertin75]

Dear JDRF:

I have heard that people with reactive hypoglycemia should eat frequent small meals and cut sugars, but my main question is why am I having reactive hypoglycemia. There must be a cause why I am having this problem (if I have it) because I don't think that its normal in people without diabetes.

I got the following paragraphs from a reputable web site of a Harvard physician regarding hypoglycemia:

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When you feel exhausted and doctors can't find a cause, they often diagnose chronic fatigue syndrome. They used to diagnose hypoglycemia.

If your doctor tells you that you suffer from hypoglycemia, he must then tell you the cause because low blood sugar is the result of something going wrong in your body. It is not a cause. Your brain gets more than 98% of its energy from sugar in your bloodstream. There is only enough sugar in your bloodstream to last about three minutes, so your liver constantly releases sugar from its cells into your bloodstream. But your liver can store only enough sugar to last 12 hours at rest, so it must manufacture new sugar from protein and other energy stores.

When blood sugar levels drop, you may feel anxious, shaky, sweaty, hungry, a tingling in your skin or your heart may beat rapidly. More severe symptoms include confusion, a sensation of warmth, weakness or fatigue, loss of memory and in its extreme, seizures and passing out. As you suffer repeat attacks of low blood sugar, they affect you less and your symptoms lessen.

There are two types of low blood sugar. First when your blood sugar rises too high, causing your pancreas to release a large amount of insulin that drops your blood sugar too low, and second, a slow drop in blood sugar caused by your liver running out of stored sugar. Doctors used to think that insulin-induced hypoglycemia follows meals and that your liver running out of sugar doesn't follow meals, but they now know that both types can occur any time.

It is almost impossible to diagnose hypoglycemia by drawing blood after you suffer an attack of dizziness, weakness or fainting because your body produces adrenalin immediately and raises blood sugar levels to normal before your doctor can draw blood. It can be diagnosed by feeding you lots of sugar and measuring your blood sugar level every half hour for several hours. If you indeed suffer from hypoglycemia, your doctor then has to find a cause that includes a damaged liver, an inadequate amount or excess of many different hormones, tumors and glandular abnormalities.
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Thanks and help is greatly appreciated.

Roberto

[JDRF Team SGG]

I know a number of people who tend to have hypoglycemic episodes who are not sick in any other way. Many of these people have been suffering from this situation for years, so assuming that a cause can be found is, I believe, expecting too much. It is wise to ask your doctor to check for tumors, to check hormone levels, vitamin levels, etc. but all the testsexcept for tumor can be done with simple blood work, and frequently all come back normal.

Some people (for instance, the folks who put out the Atkins diet) believe that the high-carbohydrate diet that is typical of the American way of life is perhaps to blame for so many people having hypoglycemia. These people believe that a diet high in simple carbohydrates stimulates the pancreas to produce too much insulin, and swear by their beliefs that going to a lower-carbohydrate diet seems to eventually solve the problem (although at first, going to a low-carb diet may actually make the problem WORSE because the person is still making the insuln but is not eating the carbs).

Others tend to believe that food allergies can evidence themselves in hypoglycemia.

One individual wrote to me to tell me that he suffered from severe hypoglycemia after starting a vitamin regimen that contained chromium. After being scared silly and going to his doctor for lots of tests, this individual realized that his sudden hypoglycemia started immediately after beginning to take multi-vitamins. His wife, a nurse, read the fine print on the bottle, and it warned that it contained chromium and that this might affect insulin absorption by the body. He stopped the vitamins and is fine again. Hypoglycemia went away.

My point is that there are all SORTS of possible causes because the body is such a complex organism. Furthermore, you wrote about the medication you are taking, and one of its side effects can be high or low glucose levels. So this may be the cause of your hypoglycemia. It is worth asking your doctor if there is another medication that may work as well that does not have this possible side effect.

IF you can find a cause, great! Then remove the cause, and you are normal again. But many hypoglycemics never find a cause. In that case, they must treat the condition with proper diet to try to prevent hypoglycemic episodes from happening or to minimize them if they DO happen. With smart food choices and education about what to do if it DOES happen, it does't cause great problems for folks who cannot find a cause and cure it entirely.  I wish you the very best.

[robertin75]

After my blood sugar has returned to normal levels (101 mg/dL in 3 hours) can I be sure that I shouldn't have any symptoms of hypoglycemia or on the other hand if my blood sugar levels are in the normal range, I shouldn't have any symptoms of hypoglycemia?
Or there is a possibility to suffer from hypoglycemia symptoms when your blood glucose levels are within the range?

Thanks,
Roberto

[JDRF-Team-LRS]

Hello Roberto,
For folks with diabetes, we can "feel" like we're having hypoglycemia when our blood sugars drop quickly.  If, for example, it drops from say, 150 to 100 in less than an hour, it may well feel like we've gone too low.  Same would be true for a drop from 200 to 150 in a short period of time -- that is, the rate of fall can trigger the adrenalin-rush feeling.

If your BG is at 101 3 hours after a meal and if it's not dropping, I wouldn't expect you to feel hypo.  

Hope this helps and good luck getting a handle on your patterns.  It's the patterns, even more than any single reading, that enable us to get some clues as to how to manage all the variables.

[JDRF-Team-LRS]

Hello again Roberto,
Your numbers seem to show that you're running at fairly low BG levels.  Since none of us here is a physician, I'd liek to suggest that you shop around for a second medical opinion, armed with all the info you shared here (and the info that was shared with you here) to push for an explanation as to *why* you're running low.

Some folks experience a period of hypoglycemia preceeding their diagnosis of diabetes.  I visualize this period as one in which the pancreas is spittin' and spurtin' because it's under duress and will, eventually poop out to some extent.  That's not a medical explanation, but to me it seems to fit the process that some eventual-diabetics have gone thru.

I get the feeling that you're not satisfied with the analysis and interpretations that you doc has given you thus far.  You deserve answers to your questions, so I hope you'll either ask that doc for a referral to someone who'll give you a second opinion or that you'll find another doc who can do that.  

Would you consider contacting the local JDRF Chapter in your area (you can visit the JDRF website http://www.jdrf.org , and click on CHAPTERS/AFFILIATES -- near the top, just under the JDRF logo), since I'd expect them to have a list of endocrinologists in your area.  These specialists are the right type of doc for us diabetics to be followed by.  I assume they're the right type of doc for a hypoglycemic person to be checked by, too.

[robertin75]

Thanks for your help JDRF

I just got some blood glucose test results taken recently and the results were:

Basal glucose: 79 md/dL (ranges 65-110)
Basal insulin: 5.73 (ranges 3.0-35.0 mcU/ml)
glucose after 20 min: 92 md/dL (ranges 65-110)
insulin after 20 min: 45.8 (ranges 3.0-35.0 mcU/ml)
glucose after 120 min: 65 md/dL (ranges 65-110)
insulin after 120 min: 8.85 (ranges 3.0-35.0 mcU/ml)



I would really appreciate if you could give me your opinion.

Thanks
Roberto

[robertin75]

Thanks for the info JDRF !

I think I'm going to look for another physician to get a second opinion because as today, nobody has tell me why am I having those low BG values. One physician told me that those low BG values are are an indication that a person is depressed, but I really doubt it. Why in this 7 years of symptoms(lack of energy mainly) I haven't found relief with the tons of antidepressants that I've taken?. Well, that's a good question that physicians have to answe me.
Thanks again.

Regards,
Roberto.