3

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Rate of insulin secretion after a glucose load (OGTT)--what is normal?

Answered on August 19, 2014
Created January 04, 2011 at 4:22 AM

I recently had an oral glucose tolerance test done with insulin levels. While my levels of glucose and insulin were all within the normal range, the insulin rose rapidly, peaked at 30 minutes, then went down quite quickly. I have not been able to find out what the normal RATE that the insulin increase should be--I have read that the most people have the insulin peak at about 1 hour, but the articles that I have looked at for the rate information are a bit too complex for me.

I'm trying to figure out whether a high 30-minute insulin level means insulin resistance or something else. I know my diet needs work--I'm working on it.

My fasting insulin was approx 6, then it rose to 86 at 30 minutes and down to 14 at 1 hour. The corresponding glucose levels were 85 (fasting), 142 (30-min), and 81 (1-hour). The test ran for 2 hours and the remaining values for glucose were 115 and 94; remaining values for insulin were 21 and 22.

If anyone has any insight, I'd appreciate hearing an interpretation. Thanks.

24868bf5aa2c49e269392765932d9dc4

(510)

on January 05, 2011
at 09:10 PM

Alan--what other ways would you recommend to test? Chris--what would be your recommendations regarding ways to manipulate/modify my diet to combat the problem?

1a8020e101199de55c1b3b726f342321

(1973)

on January 05, 2011
at 08:43 PM

This OGTT response is characteristic of reactive hypoglycemia

2b8c327d1296a96ad64cdadc7dffa72d

on January 05, 2011
at 02:51 AM

MNS - sent you an email.

5de2fffda92c0bf2be7ede10cad55546

(1781)

on January 05, 2011
at 12:10 AM

Ugg! What a horrible thing to do to your pancreas. What did it ever do to deserve that? ;p There are much better ways to test than OGTT.

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 10:26 PM

I don't get the sick feeling immediately--it is a few hours after I've consumed the offending item. thanks for the help.

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 10:25 PM

Cheryl...I tried to visit your website but it looks like it is under construction...if you would be willing, I'd like to contact you. My e-mail is [email protected] Thanks for the advice--I don't know if fruit raises my bg because I don't eat it--I'm ravenously hungry after ANY fruit. I figured this out when I was in elementary school...my lunch always had fruit in it, and I figured out I wouldn't be as hungry if I ate it first then ate the rest of my lunch. When you advise testing different foods--do you advise testing the food in isolation? I'm thinking that makes sense--is that right?

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 10:22 PM

I'm not vlc now--I've attempted more times than I could count--and always failed...

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 10:20 PM

Ed, nothing is diagnosed yet--but I have suspected that something is not completely normal with my blood sugar levels for some time. I sound like a hypochondriac, but I am just trying to figure things out--my experience with the medical community is that subtle changes/differences often are not considered legitimate. I don't mean to "doctor bash" but this has just been my personal experience. The last example of this with me was that I complained of foot pain and was told I was "getting older" when actually I had avascular necrosis.

6426d61a13689f8f651164b10f121d64

(11488)

on January 04, 2011
at 04:43 PM

@MNS, please allow me a personal question--why are you monitoring your blood glucose, and why did you get an OGTT? Do you have any particular health problems?

13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on January 04, 2011
at 04:38 PM

The meter will help you figure this out. You may need particular types of carbs as well as a particular level of carb. How long have you been vlc?

13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on January 04, 2011
at 04:34 PM

Feeling the drop is not crazy

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 02:38 PM

One more thing...exercise. I usually do cardio (yes, chronic!!) for about 30 min in the morning--fasted (well with 1/2 c. of black coffee in me). I did NOT do cardio the day of the OGTT, but the home readings are influenced by the cardio. I usually have 1 cup of coffee total in the morning, if that has any influence on things.

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 02:37 PM

Yes, in reading about diabetes and bg, I (think) I've learned that the characteristic pattern for a Type 2 diabetic is to have delayed insulin response--the phase 1 spike is diminished or nonexistent. This is almost the opposite, but the low blood sugar symptoms and variability in the glucose readings made me wonder about whether or not I'm heading for T2 if I don't get my act (my diet) together. Not sure what carb level to shoot for, since I feel crappy on vlc.

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 02:33 PM

Cont'd...I realize this is more than 3 hours, but I didn't feel "low" until that point. I know I sometimes will drop 30-50 points in a half hour time span--and this might sound crazy but I think I can feel the drop. I've brought this up with my internist (in the past) who was not at all concerned--I have an appt for a physical next week and wanted to go in armed with some information. Many docs say everything is fine as long as the values are in range--they fail to look at changes between values. I'm assuming carbs are probably too high at 30%--correct? Thank you so much for the help!

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 02:29 PM

I was definitely high carb before the test, but I will admit to poor sleep--particularly over the past 6 weeks. I've been doing blood sugar monitoring at home--the typical pattern is that I'm back to my fasting level (which is generally lower at home than what was recorded in the lab), I go up a bit around 1.5 hours, then by 3 hours I'm below my fasting level. All of my self testing has been done with mixed meals. For example, one home test with breakfast at approx. 25% protein, 30% carb, 44% fat (rough calc) at 7 am left me with a reading of 65 at 11:45 a.m.

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4 Answers

3
2b8c327d1296a96ad64cdadc7dffa72d

on January 04, 2011
at 05:41 AM

Well, the good news - your insulin responded to the BG rise.

The not so good news is that your body doesn't like glucose. Hence the high spike at 30 minutes. The good news again is that your insulin followed to take care to bring it down quickly.

The next good news is that you returned to "normal" within an hour. The 1.5 hour and 2 hour fluctuating marks should be an indication to you of insulin resistance may may develop, depending on what you eat and how you move your body. Those continued high insulin levels could lead to problems. 86 insulin is REALLY HIGH. This, without other information would suggest insulin resistance. Anytime insulin is above 80 indicates resistance. Some physicians put the figure at >70. (I believe this lower level is preferred by endocrinologists, the higher level by American Diabetes Association)

Not everybody spikes, some see a slow rise after 30 minutes and a peak at 1 hour, some others see a stead rise all the way to the 2 hour mark.

What were you eating 3-5 days before this test? What sort of exercise were you doing? How much do you sleep? Do you take other medications?

Eat/sleep/exercise3 all factor into how your body processes nutrients and what lab values you will see when you repeat this test. Did you get an HbA1C test at the same time? that level can also help you discover your path, in addition to your other blood markers (cholesterol, C-RP, etc.). If you were severely low carb before the test, your body might have a hard time processing the carbs, hence the spike.

Go get an inexpensive blood glucose meter and enough strips for 30 days. Plan your meals and test before and 1, 2, 3 hours after. No need to re-test meals that are repeated, just test "new" foods. Also record your type and intensity of exercise. A pattern will emerge that will give you YOUR best practices on what is best for you to eat and what type of exercise works to improve glucose sensitivity.

HIIT can work, but if you are overly stressed and not getting sufficient sleep, your cortisol levels will spike and make your BG spike after exercise as well.

Plan on the meter/strip protocol to cost ~$100. If you can get the strips online, you'll save a few $$$.

Please report back and let us know what you learn!

13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on January 04, 2011
at 04:34 PM

Feeling the drop is not crazy

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 02:33 PM

Cont'd...I realize this is more than 3 hours, but I didn't feel "low" until that point. I know I sometimes will drop 30-50 points in a half hour time span--and this might sound crazy but I think I can feel the drop. I've brought this up with my internist (in the past) who was not at all concerned--I have an appt for a physical next week and wanted to go in armed with some information. Many docs say everything is fine as long as the values are in range--they fail to look at changes between values. I'm assuming carbs are probably too high at 30%--correct? Thank you so much for the help!

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 02:29 PM

I was definitely high carb before the test, but I will admit to poor sleep--particularly over the past 6 weeks. I've been doing blood sugar monitoring at home--the typical pattern is that I'm back to my fasting level (which is generally lower at home than what was recorded in the lab), I go up a bit around 1.5 hours, then by 3 hours I'm below my fasting level. All of my self testing has been done with mixed meals. For example, one home test with breakfast at approx. 25% protein, 30% carb, 44% fat (rough calc) at 7 am left me with a reading of 65 at 11:45 a.m.

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 10:20 PM

Ed, nothing is diagnosed yet--but I have suspected that something is not completely normal with my blood sugar levels for some time. I sound like a hypochondriac, but I am just trying to figure things out--my experience with the medical community is that subtle changes/differences often are not considered legitimate. I don't mean to "doctor bash" but this has just been my personal experience. The last example of this with me was that I complained of foot pain and was told I was "getting older" when actually I had avascular necrosis.

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 02:38 PM

One more thing...exercise. I usually do cardio (yes, chronic!!) for about 30 min in the morning--fasted (well with 1/2 c. of black coffee in me). I did NOT do cardio the day of the OGTT, but the home readings are influenced by the cardio. I usually have 1 cup of coffee total in the morning, if that has any influence on things.

6426d61a13689f8f651164b10f121d64

(11488)

on January 04, 2011
at 04:43 PM

@MNS, please allow me a personal question--why are you monitoring your blood glucose, and why did you get an OGTT? Do you have any particular health problems?

0
Medium avatar

on January 04, 2011
at 08:03 PM

I've never had a glucose tolerance test, but I am, or at least was, one of those individuals with reactive hypoglycemia which would give me a blood sugar spike and crash and feeling of sickness within minutes of eating something like a piece of candy. Sucrose was the first thing that I ever cut out of my diet. Interestingly, I would get no such response from HFCS, honey, agave syrup etc.

If you stop eating grain etc, your post-prandial BG level should be roughly the same as what it was prior to eating. I only eat 1 piece of fruit per meal, and it is in the context of a fatty, high-protein meal so the glycemic load is reduced further.

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 10:26 PM

I don't get the sick feeling immediately--it is a few hours after I've consumed the offending item. thanks for the help.

0
2b8c327d1296a96ad64cdadc7dffa72d

on January 04, 2011
at 04:46 PM

For Type 2, you certain CAN have an early spike, a drop and then a SECOND spike! Not all patterns are the same, because it does depend on how YOUR body responds to carbohydrate.

I'm not advocating VLC, necessarily, but perhaps shifting the kinds of carbs and the time of day you eat them.

For example, let's say you can eat a plate of pasta (not advocating, this is just an example), with minimal blood sugar spike over 3 hours, yet eating oranges and apples causes the spike like you saw in your blood work.

The shift you might consider in your diet is to eat those carbs earlier in the day, take your exercise earlier in the day, and cut most carbs except for colorful vegetables for the rest of the day.

Before breakfast: exercise (some cardio, some resistance training)

Breakfast: eggs + bacon spinach & sweet potato

Lunch: salmon salad (roasted salmon over mixed greens, mustard vinaigrette dressing), berries

Dinner: stuffed eggplant (stuffed with veggies, italian sausage and an egg or cheese to bind)

Could you manage something like that? Try the 30-day meal plan suggested in Robb Wolf's Paleo Solution. It isn't VLC, the dishes are easy to make with readily available ingredients. best of all, you don't need to worry about macronutrient ratios unless you are a data geek.

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 10:25 PM

Cheryl...I tried to visit your website but it looks like it is under construction...if you would be willing, I'd like to contact you. My e-mail is [email protected] Thanks for the advice--I don't know if fruit raises my bg because I don't eat it--I'm ravenously hungry after ANY fruit. I figured this out when I was in elementary school...my lunch always had fruit in it, and I figured out I wouldn't be as hungry if I ate it first then ate the rest of my lunch. When you advise testing different foods--do you advise testing the food in isolation? I'm thinking that makes sense--is that right?

2b8c327d1296a96ad64cdadc7dffa72d

on January 05, 2011
at 02:51 AM

MNS - sent you an email.

0
B2157bdf4a217ac943c41125d1a67845

(258)

on January 04, 2011
at 10:52 AM

You responded really well to the glucose. Many, many people would shoot up near 200 and take longer to return to normal. Spiking at 30 minutes is excellent. The worse your response time, and the higher your blood sugar spike, the closer you are to diabetes. As a diabetic, my blood sugar will rise way over 200 and my blood sugar spike will occur around 2 hours after taking glucose.

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 02:37 PM

Yes, in reading about diabetes and bg, I (think) I've learned that the characteristic pattern for a Type 2 diabetic is to have delayed insulin response--the phase 1 spike is diminished or nonexistent. This is almost the opposite, but the low blood sugar symptoms and variability in the glucose readings made me wonder about whether or not I'm heading for T2 if I don't get my act (my diet) together. Not sure what carb level to shoot for, since I feel crappy on vlc.

13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on January 04, 2011
at 04:38 PM

The meter will help you figure this out. You may need particular types of carbs as well as a particular level of carb. How long have you been vlc?

24868bf5aa2c49e269392765932d9dc4

(510)

on January 04, 2011
at 10:22 PM

I'm not vlc now--I've attempted more times than I could count--and always failed...

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