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GTT on Low Carb?
May 15, 2011
4:52 pm
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August 28, 2010

Cathy

 

Is it advisable for someone on a low carb diet to undergo a GTT?  How does 75g of pure glucose affect someone who normally eats <20g carbohydrates per day?  I think I'd get sick!  What about the advice to eat 150 carbs per day for 3 days preceding the test?  I have not had that many carbs in a long time and I'm reluctant to ruin my low carb diet.   Yet, I would like to take a GTT to see if I am diabetic.  My fasting BG is usually 100+ but my postprandial BG is good… then again, I eat very few carbs!  What should I do?

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Robert K. Su MD

 

Post edited 8:08 pm – August 28, 2010 by Robert K. Su MD


I do not see why someone with low carb diet cannot have GTT, although 75 grams of pure glucose is very large in comparison with a diet of daily 20 grams of carbohydrate. However, if the person on low carb diet is a type 2 diabetic, depending on the duration and the severity of his diabetic condition before switching to low carb diet, he might and should find that his beta cells are functioning better in the GTT in comparison with that he had previously with high carb diet. But, I really hate to abuse his stable blood glucose for one GTT event. He should not eat any more carbohydrate for the rest of that day after GTT and returns to his routine low carb diet as soon as possible. 

If he is going to have a GTT, I would suggest he should ask for the data of BG readings throughout the entire two hours. As said before, the data of the entire two hours is more informative than the readings of FBG and two-hour-PPT. 

Okay, this is your case, Cathy. What was you FBG before you switched to low carb diet? Your current FBG is probably incorrect because there is  or are other factors involved. Although you had a normal two-hour PTT, I guess it was not done is a setup for GTT, rather the readings at two hour mark after meal. But, do you want to get a GTT done, unless recommended by your doctor? It is not as important to know if you are diabetic as much as if your diet affords a stable postprandial blood glucose level with the normal range. So, if I were you, I would not take GTT. But you should take a serial postprandial blood glucose test by yourself. Start a test before a meal or fasting BG if this is done for the breakfast. Then you begin to eat your meal. Continue to take blood glucose test once every 15 minutes after the first one and until two hours after meal. If the blood glucose reading at the two-hour mark is still over 120 mg%, you might want to keep on for another hour or until the reading returns to the preprandial or FBG. If you have a very smooth and low or small excursion of BG, you know that your diet is good. If your BG reading returns to the preprandial or FBG sooner than two hours, you know that your beta cells handle your diet well and you are diabetic at this point. Be careful, this does not mean that you should go back to high carb diet, which will ruin your beta cells eventually and make you diabetic.

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10:07 pm
August 28, 2010

Cathy

 

Before switching to low carb, I was unaware of my FBG.  The reason I started testing FBG was to find a baseline to compare postprandial BG levels.  When I first starting low-carbing, I relied on  "Low Carb" bars and shakes to get through the day (I think I was having withdrawal symptoms back then). The products made me feel dizzy, and I was not able to lose weight so I began to wonder if they were truly low carb..Confused That's where the BG tests came in.  

To my surprise, my FBG was 136 the first time I took it though I had been low-carbing for 3 weeks.  (I knew that was high from from previously having Gestational Diabetes.)  I bought a new meter and test strips, and FBG was 126. Still high. I gave up all artificial Low Carb products  and after a few weeks my FBG went down to 115.  By 12 weeks, it now is 105-110 though I had a recent level of 100 Embarassed  I understand a truly healthy range is under 100, so I still want to push it down further.  Do you think it will continue dropping with continued low carb eating?  My husband, who eats an enormous amount of carbs, has 65-70 in the morning. I don't understand how that is possible, and it has made me wonder if I am diabetic. 

Regarding post-prandial, my BG usually rises 5-10 points after breakfast then goes down to 90-95 at 2 hours and stays there all day. (Interesting how BG is lower after eating; is it too much insulin?)  When I eat, it goes up to 100-105 then back down to 90/95 in 2 hrs. I've not tested every 15 minutes yet, but that would be interesting to see…. I will try it! Embarassed

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August 28, 2010

Robert K. Su MD

 

Okay, I remember your history. With the past gestational diabetes, you are at risk of becoming diabetic, if you are not yet at this point. So, switching to low carb diet is the right thing to do. Unfortunately, about the low-carb bars and shakes, they are not necessarily "low carb" at all. I was told by others that their BGs went up instead, with the bars and shakes, until they stopped taking the stuff.

Your first FBG at 136 was certainly an indicator that you might be diabetic. Then you did the right thing by stopping the low carb stuff. Now your FBG is around 105-110, which is not necessarily bad. The most important that you should do is to conduct a serial BG tests as I described and see how your low carb diet and beta cells will do. If you see your BG returns to the preprandial level quickly, say in 30-45 minutes, your low carb is great and your beta cells are not bad. If it returns to the preprandial level within two hours, but has never goes up over 120 mg%, the foods are okay, If the BG goes over 120 mg% but not over 150 mg%, the foods need to be checked for too many carbs, which your beta cells cannot handle well.  If you do the serial blood tests, please let me know, I'll explain the results for you. 

Yes, your husband is eating lots of carbs with FBG at 65-70 mg% that is not necessarily a good thing. His insulin is probably produced more than his blood glucose needs. But this is likely a prelude to diabetes mellitus or pre-diabetic. He might have experienced hungry and weakness, even cold sweat occasionally in the middle of morning or afternoon or both before the mealtime. If he did, that was a hypoglycemia attack. You can ask him to try a serial blood glucose tests and see how high his BG will go after meal. He may have normal FBG and 2-hour PPT readings with a big postprandial BG excursion. If that is the case, his beta cells are working very hard or overworking. He should watch out, and perhaps, need to limit carb intake.Smile

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August 28, 2010

Cathy

 

Yes!  My husband does get cold sweats and I didn't realize it was due to hypoglycemiaSurprised.  It makes sense now, because he does not seem to realize when he is hungry.. his stomach never growls so he goes on and on without eating, then his hands tremble and he becomes sweaty and does not feel well.   I just thought it meant he was very hungry… now I feel bad!  Frown  When he does eat, he eats quite a lot of carbs – at least 100 per meal due to lots of bread and soda.  So he goes from one extreme to another.  I will tell him what you said about hypoglycemia and that having lower FBG does not necessarily mean he is healthier than me!  Perhaps I can even convince him to test his BG during the next cold-sweat attack.  I'll also perform the serial testing you recommended and share the results…  I'll need to get a fresh supply of strips first as I'm almost all out.

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August 29, 2010

Robert K. Su MD

 

After reading my book, you should have realized that restricting carbohydrates is not just weight loss but more importantly also  for restoring and maintaining good health. More than 99.9999% of us do not realize how terrible the roles of hyperglycemia impact on our health. To make it worse, 99.9999% of doctors today still in a state of denial that eating carbohydrates has anything to do with the development of diabetes mellitus. Just taking a look at what both AMA and ADA have told us about watching hypertriglyceridemia, at the same time, these organizations and the governmental health agencies still promote carbohydrate-rich, fat-restricted diet, simply forget that the more carbohydrate consumption, the worse hypertriglyceridemia will be. No wonder so many more people become diabetics year after year. Yell

Now, unfortunately, you husband does have the possibility of pre-diabetic and should take care of himself too about his diet. As soon as you get the test strips, please conduct a series of postprandial blood glucose tests. I can expect his postprandial BG will be over 200 mg% or more easily, even he may have normal readings of FBG and 2-hour PPT or 2-hour postprandial test.

Acute and big postprandial blood glucose excursion is the most dangerous situation. As mentioned, the situation is the risk of acute coronary artery syndrome and stroke. In addition. many diseases are positively tied to the chronic hyperglycemia.

Please let me know of the results. Although I wish I can give a presentation to many people at one time, I do not mind to save one life at a time.Smile

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August 29, 2010

Ben Fury

 

Self testing is definitely the way to go in this case.

Here's some instructions for running a carb challenge post meal test:

http://www.phlaunt.com/diabete…..046889.php

 

An office visit OGTT is not the best thing to get done for several reasons. A very important one is if your doctor does an OGTT and pronounces you a Type 2 diabetic, your chances of getting life or health insurance at any reasonable rate just went down the tubes.

 

I'm not saying you shouldn't see a doctor. If you're ill, you need help and should get it. But if your BG response is a little off, there's a lot you can do with diet that few doctors are aware of.  And getting a low A1c with diet is a worthy goal for any of us, diabetic or not.

Smile

 

Be well,

Ben Fury, CFT, CMT

Bettercise

A happy life is just a string of happy moments. But most people don't allow the happy moment, because they're so busy trying to get a happy life.

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September 1, 2010

Cathy

 

I just got some very bizarre results after a series of BG tests I took after dinner.  I ate dinner between 6:15 and 6:30 and did not eat anything afterward while conducting the BG tests.  Initially, my BG began to rise and peaked at 140 by 1 hour postprandial. Then it began to fall, as expected….  But THEN it began to rise again, even though I did not eat anything since dinner. By the 3rd hour my BG was finally back down,  but not to the preprandial level.  What do you make of this?  Here are the results:

 

6:15pm preprandial 90

6:30 Postprandial 92

6:45 postprandial 122

7:00 Post 133

7:15 Post 140 (1 hr)

7:30 Post 125

7:45 Post 119

8:00 Post 108

8:15 Post 107 (2hrs)

8:30 Post 107

8:45 Post 111

9:00 Post 124

9:15 Post 132 (3 hrs)

9:16 retest 124

9:17 retest 135

9:30 Post 100

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Robert K. Su MD

 

Yes, Cathy, your postprandial BGs were a bit of fluctuating. Could you tell what you had for dinner? Did you have alcohol? Did you have exercise, physical activities or excitement? All these were possible  factors.

Let me share with you the following two slides, which are described in my book. The first slide shows you a biphasic BG level, because I ate a cup of Cheerios after finishing a very carbohydrate-restricted breakfast. The first peak was dampened by the breakfast. The second peak finally returned after the dampen effect by the breakfast was eased. However, the strength of the cheerios was weakened. The second slide shows a monophasic BG level was solely a response to a cup of Cheerios. The slides are large enough for you to review.Smile

 

Cheerios1[Image Can Not Be Found]

Cheerios2

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Ben Fury

 

Robert K. Su MD said:

I ate a cup of Cheerios 


Cheerios has a glycemic index (GI) rating of 74 and a glycemic load (GL) of 12… and it pushed your BG all the way up to 180!
 

This shows why I think GI and GL are basically useless. GL of 12 and it drove your BG up into the range where it will create organic damage if it stays there for long.

 

The more important index is the Insulin Index, but very little research has been done on it.

How does food affect our insulin response?

 

Be well,

Ben Fury, CFT, CMT

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September 2, 2010

Robert K. Su MD

 

Post edited 12:21 am – September 2, 2010 by Robert K. Su MD


Sorry, I do not understand what you are saying. Please explain to me why GI and GL are useless. The slides are from my personal experiments. I absolutely understood how grains and cereals are affecting the body.

Glycemic index is just for everyone to learn what the potential of each food is in raising the BG level. It does not tell him that a food with a GI of 72 will raise so much of BG in his postprandial phase. Glycmic load is just to offer everyone an idea that two foods with different GI but the GL can be the same if consuming more on the food with a low GI. In other words, one should not think, for example, blue berries have considerably lower GI and he can eat a lot of them. GI X amount of consumption = GL. Thus, 10 X 1 = 1 X 10. Always, the body is live and involves variable factors. Any index is just a guideline or reference. How can one be sure that he takes in 2,000 calories and his body will absorb all of the 2,000 calories into his circulation and tissues? Absolutely negative!

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Ben Fury

 

Robert K. Su MD said:

Sorry, I do not understand what you are saying. Please explain to me why GI and GL are useless.


Useless is too harsh; next to useless is more accurate. The net carb load will be the same over time, no matter the GI or GL. And while testing GI and GL, researchers found huge differences between test subjects and even between the same subjects on different days.
 

The impact on insulin response is more important than the effect on the BG. And although this tracks similarly to GI/GL in some foods, it is enough different in other foods that we really should be using Insulin Index to judge whether things are healthy to eat or not. Some carb free foods create quite an insulin response and some carb loaded foods have surprisingly high or low insulin responses.

 

Compare GI vs Insulin Index here.

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Cathy

 

For the sake of the experiment, I ate a product called Dreamfields Pasta which claims to be a "healthy" pasta having only 5g of "available" carboyhydrates per serving.  http://www.dreamfieldsfoods.com/diabetes-diet.html  It is not one of my normal foods;  I chose it because I wanted to see if the claims were true, and if they were not, I wanted to see how my body would handle the extra carbohydrates.  I carefully measured 2oz of dry product and boiled exactly 10 min.  After draining, I tossed it with 1T butter and 1T grated parmesan cheese.  I didn't eat anything after that and had a normal evening helping children with homework and getting them ready for bed.  I gave up testing after the 9:30pm reading and had a snack of coconut custard at 10pm before going to bed (3T shredded unsweetened coconut + 1/3 C Unsweet coconut milk + 1 pkt Splenda).  When I woke up this morning, my FBG was 119 at 6:00am Frown  It hasn't been that high in several weeks. 

 

Thank you for the slides Dr. Su, that is very interesting to see!  I do remember that from your book.  Why do you suppose I had a biphasic BG level when I only ate 1 food? Confused  Yours makes more sense since you ate 2 items, the second of which was very high in carbs.

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Robert K. Su MD

 

Cathy, first of all, it is not a good idea to conduct experiment with two or more variables. That makes us difficult to interpret  the results. You remember that I told you of playing the game of elimination. We have to keep everything constant except the subject for study. In your results, I cannot fully explain why you had biphasic postprandial BG, except the new Dreamfields Pasta, which you tried. I suspect it has more than 5 grams of "available carbohydrates" per serving. I found the nutrition facts of many food packages are inaccurately stated. The other thing that I need to know is the amount of the pasta you ate. Of course, the more you ate the more your BG would go up. Besides, I need to know is the ingredients of the product. Usually, starchy foods take a longer time to raise the BG level up and last longer. Therefore, my explanation is you used butter and cheese, which dampen the the first spike of BG. By the time, butter and cheese were gone, the dampen effect disappeared and the lasting effect if starchy foods made the second spike. Below, you can see the nutrition facts on total carbohydrate is terribly incorrect! If you would like to do another experiment, please use your regular dinner, which you have taken for carbohydrate restriction. In this way, you can examine the fact that the level of your BG during the postprandial period and see if your dinner has anything to do with your fasting BG in the morning.Smile

 

Nutrition Facts

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Ben Fury

 

Dreamfields Pasta is a very weird product. Way too frankensteinish for my tastes.

David Mendosa had this to say about it.

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