[*ac*]

Originally Posted by ninasnr

I had a patient who had a GTT, and it was high indicating Diabetes. About 10 years earlier, was diagnosed with hypoglemia. The patient refused to take the actos that was ordered (after DX of Diabetes) because it made the patient feel 'bad'. Dizziness, tired, hungry, etc. So patient was unmedicated. Pt came in with hypoglycemia through ED, was given D50 x2, was given breakfast, and BG was still unstable 50-60's. Pt admitted with D10 continuous IV, was in for 3 days. Various tests were done checking for tumor on pancreas etc, nothing was ever found. Was taught diet for hypoglemia. I later heard pt was again diagnosed with DM. What do you make of this? Any ideas? It sure confuses me! Could this be weight related? The patient had weight fluctuations.

It's a strange scenario but I have heard of it before. Sometimes patients have hypoglycemia preceding true DM. It seems like sometimes the pancreas/liver go a little nuts before giving out. I think it's pretty rare, though. What is the pt's HbA1c? Has he/she EVER had a high fasting bg?

[dansingrn]

Perhaps the patient with DM with an HbA1c of 4.9% was never diagnosed by high fasting glucose levels. The OGTT is more sensitive than the fasting plasma glucose. One of the diagnostic criteria for DM is a BG >200 2 hours after a glucose tolerance test. (This is confirmed by repeating the OGTT). This patient might have failed the OGTT and started on meds and diet/exercise to improve insulin sensitivity.
If the 2 hour result is 140-199, this is called IGT (impaired glucose tolerance) and is often treated with meds before overt diabetes is diagnosed. It is possible that a person could have IGT and mistakenly believe they have been diagnosed with DM. This sometimes happens when clinicians are not very careful in explaining test results to patients. The treatment may look almost the same as DM, but in fact be prescribed to prevent or slow the progression to DM. In this case, the blood glucose levels may remain mostly in range, thus the great looking HbA1c, but the potential exists for hyperglycemia if the diet isn't carefully watched.
HbA1c of 4.9% is roughly equivalent to an average glucose of 87mg/dL. Previous posts already explained well how this test isn't technically an average, and can be very misleading if made up of wide BG swings.
Sorry this is so long. Hope it helps.

[VivaLasViejas]

Actually, it does help explain something for me. My recent A1c was 5.4, which I thought was odd given the fact that for two months my fasting blood sugars were in the 140s-150s regularly (I've been able to bring the average down to the low 100s with dietary changes over the past six weeks or so). Maybe the A1c was simply telling me my sugars were up and down a lot; I knew I was having a lot of "crashes", although I rarely checked my BG then due to shakiness and confusion (not to mention that I usually was nowhere near a glucometer when these things occurred).

Anyway, whenever I crashed, I'd eat and drink anything I could find with sugar in it. I could consume a day's worth of calories in 10 minutes by drinking regular soda and eating half a box of candy---ANYTHING to make that out-of-control feeling go away. So I imagine my BG probably skyrocketed after that (didn't check it then, either). I'd get so thirsty and tired when it was up, although the highest reading I ever saw was 200. However, that was after a normal noon meal, not binge-eating in response to a crash, so I don't really know how high my blood glucose actually went.........it was a real rollercoaster ride, I can tell you that.

[ninasnr]

Re:
I had a patient who had a GTT, and it was high indicating Diabetes. About 10 years earlier, was diagnosed with hypoglemia. The patient refused to take the actos that was ordered (after DX of Diabetes) because it made the patient feel 'bad'. Dizziness, tired, hungry, etc. So patient was unmedicated. Pt came in with hypoglycemia through ED, was given D50 x2, was given breakfast, and BG was still unstable 50-60's. Pt admitted with D10 continuous IV, was in for 3 days. Various tests were done checking for tumor on pancreas etc, nothing was ever found. Was taught diet for hypoglemia. I later heard pt was again diagnosed with DM. What do you make of this? Any ideas? It sure confuses me! Could this be weight related? The patient had weight fluctuations.

This patient did have elevated fasting BG a couple of times, reportedly but less than 150.

[classicdame]

there are other things besides diabetes that causes fluctuations in metabolism. This patient needs to see an endocrinologist, IMHO

[Miami NightNurse]

I know I am a bit late adding to this but I got a big mouth and I am a diabetic and I just have to put my in . An endocrinologist will not just use a HgbA1C, they will also have patient bring in their Blood sugar machine and download their results onto computer and it will come up with a nice little graph giving the highs and lows. Here's the HgbA1C=what average glucose
HgbA1C: Average Blood Sugar for 3 months:
4--------------- 60
5--------------- 90
6 ---------------120
7 ---------------150
8 ---------------180
9--------------- 210
10------------- 240
11------------- 270
12-------------- 300
13-------------- 330

[dansingrn]

Quick little formula for figuring BG average from A1c:

A1c - 2 x 30 = BG average

example: if A1c is 9.6%-2x30=228

[Miami NightNurse]

Originally Posted by dansingrn

Quick little formula for figuring BG average from A1c:

A1c - 2 x 30 = BG average

example: if A1c is 9.6%-2x30=228

Thank You!!! I didn't know that. I love this site I learn something new every day.