Hello Customer (name blocked for privacy),
Thank you for your question.
You need to have what is called a "4 hour Glucose Tolerance Test" also known as a "4 hr.GTT." This is where the patient has to drink the "yucky stuff." The yucky stuff is a high carbohydrate load and is obtained through your Dr.'s office and blood levels are drawn at different intervals throughout the test. This screening blood test helps diagnose conditions of impaired glucose metabolism. Generally, the patient drinks a set amt. of carbohydrate and then the blood sugar is monitored at 1/2 hr, 1 hr., 2 hrs. and often continues to be monitored at 3 and sometimes 4 hrs. In the patient who does NOT have "impaired glucose metabolism" there will be a rise, then a fal in the glucose level. In the patient who is a DIABETIC, the rise in the blood sugar level continues throughout the testing of the blood.
Abnormalitites of the 4 hr. GTT may indicated the following possibilities: Hypoglycemia, diabetes, possible tumor of the pancreas or Cushings Syndrome.
Before the 4 hr GTT is done, you need to be sure you have eliminated factors which might interfere with the accuracy of the test: Tea, coffee, excessive stress, smoking and caffeine containing beverages have been shown to affect the GTT results so avoid these factors to help ensure that the GTT is as accurate as possible. Also, exercising lowers glucose levels so do not exercise before this test is done. Some medications are known to increase glucose levels and may indicate an intolerance, examples are: beta blocker medications, antiinflammatory meds. (Naprosen/Aleve, Ibuprophen/Motrin, Aspirin), medications used for hypertension which are not beta blockers, thiazide diuretics, multiple antipsychotic medications, birth control pills are examples of some of the medications which can interfere with the testing. Be sure to remind your Dr. what medications you are taking and ask if any of your medicine will interfere with the accuracy of the GTT.
Normal findings of the GTT in the adult patient are:
Fasting: 70-115mg/dL
30 minute blood draw: <200mg/dL
60 minute blood draw: <200mg/dL
120min. (2 hr) blood draw: <140mg/dL
180min. (3 hr.) blood draw: 70-115mg/dL
240min. (4 hr.) blood draw: 70-115mg/dL
Testing of the urine may or may NOT be done during the 4 hr GTT. Normally, there is NO glucose found in the urine. Blood serum levels of glucose are the most accurate testing results, urine testing is less accurate.
It is very important that you fast for 12 hours before the GTT. It is also very important that for the 72 hours PRIOR to the test that you have consumed diet containing moderate amts. of carbohydrates.
The GTT should never be done on anyone with a fasting blood sugar significantly elevated. If your fasting BS is found to be significantly elevated, then the person who normally conducts the GTT should always notify the MD who ordered the test for instruction. This is because there is significant risk of inducing a HYPERGLYCEMIC reaction to the patient.
HYPOGLYCEMIA signs and symptoms: dizziness, fatigue, sweating, hunger. shakiness/tremors. Patients need an emergency source of glucose immediately available and should eat a protein (i.e.milk) as soon as possible.
HYPERGLYCEMIA signs and symptoms: Hunger, thirst. headache.
You have reason for concern, Customer (name blocked for privacy). 1)If you have a low 200 reading on the glucometer prior to eating, this needs to be reported to your MD. 2)Your family history with a mom having diabetes and your daughter also shows there is a clear familial tendency for diabetes.
My recommendation is that you: make an appointment as soon as possible with an ENDOCRINOLOGIST. You can locate an endocrinologist in your area by going to this website: www.aace.org . This is the American Association of Clinical Endocrinologists web address. Scroll to the bottom of the opening page and you will see, in small print "Find an endocrinologist." Click on that, then you will be directed as to how to find a Board certified and member of the Association of Clinical Endocrinologists complete with all contact information and directions to practice. When you call for an appt., you need to emphasize that you would like an appt. as soon as possible because you have confirmed you have a glucometer reading of low 200's. As you know, such a reading is indicative of diabetes. A 4hrGTT is the most reliable objective testing method available to determine confirmation of diabetes. I advise that you conduct glucometer readings just prior to each meal and if you have signs and symptoms of not feeling "right" then ALSO take a reading then. Be careful to keep a log of every reading with the time and date listed and how you were feeling at the time the glucometer readings are taken (hungry, thirsty, headache, excessive urination, tremors, etc. etc., anything "abnormal" in the way you are feeling.) Keep a careful log of every morsel of food consumed and the time eaten, quantity. Measure your servings with a measuing device, weigh the portions of meats with a food scale. Best way to do this is to have a spiral bound composition book of normal school size and log everything I have mentioned above. On the day of your endocrinology appt., take this composition book of data with you and share it with the endocrinologist. The endo. will then guide and advise you as to what is needed next for any testing. I am sure an A1C will be done. You likely are aware that you can buy A1C testing kits at your pharmacy for at home testing.
After consulting an endocrinologist, I suggest you make an appt. to consult an ophthalmologist if you do not have one already. You want to establish regular follow up appointments to have your eyes examined and check for untoward signs of the effects of diabetes and certainly to maintain the integrity of your vision as best as possible. You should also consult a podiatrist and maintain regular follow up visits with a podiatrist and if you find one with a special interest in diabetic foot care, all the better.
I do understand why you are somewhat scared. Your indicated glucometer reading and family history are definitive and justifiable reasons for concern. The sooner you consult an endocrinologist for evaluation and guidance, the better. Please contact an endocrinologist's office on Monday and schedule an appt. If you have a PCP and require referral, then call the PCP's office and explain you need to be referred of an endocrinologist and why (same reasons you wrote to us at this site and that you require further evaluation...) Before you call the PCP's office, you can check out the website of the aace I mentioned and have names of endocrinologists in your area and compare with you HMO participating specialists roster and choose an endo. This way, when you call the PCP's office, you can state the name of the endo. with whom you have chosen to be referred....
I hope this information has been helpful. If I can be of further assistance, let me know. Thank you.
Edited by gotquest on April 2 2006 at 10:51am
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