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Diabetes - Type 2 Community
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875426 tn?1325528416

Is a glucose tolerance test in order?

I have a parent who has been having some symptoms that might point to diabetes, or they might not.  I found on one site where a person can get weight gain with it (they've gained weight recently though stating not eating differently) along with fatigue and trouble with possible thrush (got treated for it).  

Testing of HgA1c was a bit above range once- I think maybe at 6.1.  And the second time, with a cut back in sugar intake was at 5.6 (reference range, less than 6) .   At the same time that second HgA1c was taken, a random blood sugar came out low at 67. (Reference range they gave of 74-106 I think was actually for fasting, though not my parent was not fasting- it was four something in the afternoon.)  

Can anyone here with diabetes tell me what they think might be going on and if they think the glucose tolerance test offered by the doctor prior to these second lab numbers should now be requested anyway by my parent?
17 Responses
231441 tn?1333892766
COMMUNITY LEADER
Hello,

when someone is in the early stage of diabetes, their pancreas doesn't work as well as it should.

So the person eats food with carbs.  The pancreas can't put out enough insulin and so blood sugar goes high, finally though the pancreas catches up and produces enough insulin, but it may overshoot a little.  So highs can be followed by 'relative lows'.

This may be the case, which is why we recommend further checking for diabetes.
141598 tn?1355671763
The American Association of Clinical Endocrinologist guidelines:
● Ac1 = <5.4 % as normal, 5.5-6.4 impaired [prediabetes], 126 mg/dl

Maintaining normal body weight, abstaining from eating sugary foods, eating a low carb diet, and daily 30-60 exercise can help reverse prediabetes.A follow up FPG or an oral glucose tolerance should be used for definitive diagnosis.
141598 tn?1355671763
My previous post omitted the following
- Fasting plasma glucose [FPG] normal is 60/70-99 mg/dl
- Fasting impaired glucose [prediabetes] is 100-125 mg/dl
- Fasting diabetes >126 mg/dl
231441 tn?1333892766
COMMUNITY LEADER
A glucose tolerance test is in order.  Sounds like your parent does have some indications that could mean diabetes.

However, if it is early lifestyle measures as mentioned above should be very helpful in managing it.
875426 tn?1325528416
Thanks to both of you for responding!  I let her see your answers!  

Why would my parent have a low random blood sugar in the afternoon?  Does that normally sometimes happen with pre-diabetes?
141598 tn?1355671763
The reference range of 74-106 is unusual. A low range of 67 mg/dl is not considered low, below 60 is. One can purchase home glucose meters at almost all drug/pharmacy stores including Wal-Mart. Some run as low as $10. It might behoove your parent to test on their own.
875426 tn?1325528416
Is the reference range supposed to be below 60 to be considered low even for someone who has not been fasting, as my parent was not?  I believe it was the hospital lab the doctor used that flagged the 67 as low.  
875426 tn?1325528416
Thanks, Sally, for explaining!  My parent is planning to try a low carb diet model and hopefully ask for further testing at a May 29th appointment.
141598 tn?1355671763
"Is the reference range supposed to be below 60 to be considered low even for someone who has not been fasting, as my parent was not?"

One is supposed to fall "between" the reference ranges, not below or above. Doesn't matter if the patient has been fasting or the test is random [excludes OGTT [oral glucose tolerance test]]. A doctor may perform random glucose 'blood' testing to see if glucose varies widely throughout the day. Healthy peeps do not. HTH
875426 tn?1325528416
Note- I hope you now know my intent.  I'm sorry I misspoke in my post.

I meant to say:
Is the blood sugar supposed to be below 60 to be considered low even for someone who has not been fasting, as my parent was not?

  I already was aware a person's lab specimen when measured is supposed to fall within the APPROPRIATELY printed normal reference range (I don't really think the one the lab printed was the right one for a random specimen).

But while you had cited the reference range for a fasting blood sugar test which had the bottom number of the range as 60 and did not at first very specifically apply it to a random blood sugar specimen in a previous post, in a later post, you went on to say 67 is not considered low, hence the clarifying question I asked you.
141598 tn?1355671763
Earlier on I commented, "Fasting plasma glucose [FPG] normal is 60/70-99 mg/dl". No mention of 'random'. My labs or doctors do not consider 67 as low, borderline, yes, but not low. However, your parent's doctor may feel otherwise. Hence the / between 60/70.

"(I don't really think the one the lab printed was the right one for a random specimen)"
The lab copy should define the type of test. If not ask the doctor and/or contact the lab for an explanation. My hospital has its own lab but sends certain samples to an outside independent lab for analysis. Both can be contacted.
875426 tn?1325528416
Just spoke w/the supervisor of the hospital lab.  She says blood sugar should be back to normal if it's been more than two hours after eating or something like that (which it likely had been for my parent).  She says their reference range is established by testing of people in our specific region and is regulated by some official agency or other (I think a state government agency).  She claimed through the tech I spoke to prior to her that fasting and random have the same range.

So far, the doctor has left it to other of his staff to report results who do not know the meaning of them all & my parent has not insisted on talking to him on the phone, but is content to wait until a future appointment.
141598 tn?1355671763
Thanks for updating us. Try asking the lab supervisor if it's possible to mail all future lab results directly to your parents. This way your parent and yourself won't have to rely on a staff member and you also will have a record on hand.

875426 tn?1325528416
My mom had gotten the first Hga1c, which was higher than 6 by phone, but we didn't find where she wrote it down, but I think it was 6.1.
  I think that was done at the lab there in the doctor's office, where they send out to an independent lab.  

The next results from the hospital lab, she did get copies of, but not through the mail.

I know I've gotten differing results on a different kind of blood test on the exact same day between the doctor's independent lab and the hospital's ER lab (was advised to go to ER after visit).

If my mom were to think about getting a home blood sugar testing device, what would be the most accurate ones out there?
141598 tn?1355671763
Per Consumer Reports, the #1 & #2 meters were Accu-Chek Compact Plus and Accu-Chek Aviva. Both run around $20. CR Best Buy went to ReliOn meters [all three of them] sold at Wal-Mart [approx $10] with annual low cost of test strips approx. $570. Accu-Chek strips came in @ $1700 annually.


875426 tn?1325528416
Thanks for the consumer report info!
141598 tn?1355671763
You're welcome
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