Is it possible to have insulin resistance with a normal fasting blood glucose and a normal fasting insulin level? It's both my postprandial glucose and insulin that are really high (300 for the glucose, around 45 for the insulin). Actually my fasting insulin is below the lab normal value (usually 3 or lower, lab normal: 6 - 17), with normal fasting glucose. Can anyone tell me if this pattern is consistent with insulin resistance or if it is suggestive of some other problem?

Thanks in advance!

Liz

The fact that you have such high postprandial numbers is significant in itself and warrants further investigation by an endocrinologist. The fact that your insulin levels postprandially are very high indicates insulin resistance. Your body is requiring more insulin to lower your glucose. Often in earlier stages of T2, your fasting numbers will not be too high. Can I guess that your numbers come down fairly rapidly after a couple of hours? I think you certainly need to look into this further because clearly you're experiencing significant postprandial highs. Keep us posted. :)

The fact that you have such high postprandial numbers is significant in itself and warrants further investigation by an endocrinologist. The fact that your insulin levels postprandially are very high indicates insulin resistance. Your body is requiring more insulin to lower your glucose. Often in earlier stages of T2, your fasting numbers will not be too high. Can I guess that your numbers come down fairly rapidly after a couple of hours? I think you certainly need to look into this further because clearly you're experiencing significant postprandial highs. Keep us posted. :)

I have been to two endocrinologists and neither of them have done anything beyond the glucose tolerance test. Could you tell me what types of tests they should be doing so that I can get to the bottom of this? My blood sugar is getting really difficult to control, to the point where I can't eat carbs, and I already have some neuropathy which is probably the result of this. And you're right, after about three hours my blood sugar goes down really fast. At this point I'm just frustrated because I have been unable to find a doctor who will take this seriously.

Thanks,
Liz

What were the results of the GTT? I would imagine you went really high and then began to drop really fast in the 3rd or 4th hour? Are you on any medications? Some meds like steroids for inflammation can cause insulin resistance. I don't know exactly what else to suggest, other than trying another endo. I'm trying to find a new endo too right now. They should definitely run a GAD antibody test, just to be sure you don't have the antibodies predisposing you to T1. The endo should run a C-peptide if they haven't although it seems like they may have. Hmm... I'm wracking my brains to try and figure out something to help you... There ARE less common types of diabetes, like MODY, but I'm thinking you are more along the lines of T2. The odd thing is the normal fasting glucose with such postprandial highs. Oh, have the endos ran an HbA1c? In case you don't know, that would be a three month average of your BG. My immediate suggestions, besides the new endo, would be to limit your carb intake as much as possible so you hopefully don't spike after meals. Let me know whats happening with you, and good luck.

What were the results of the GTT? I would imagine you went really high and then began to drop really fast in the 3rd or 4th hour? Are you on any medications? Some meds like steroids for inflammation can cause insulin resistance. I don't know exactly what else to suggest, other than trying another endo. I'm trying to find a new endo too right now. They should definitely run a GAD antibody test, just to be sure you don't have the antibodies predisposing you to T1. The endo should run a C-peptide if they haven't although it seems like they may have. Hmm... I'm wracking my brains to try and figure out something to help you... There ARE less common types of diabetes, like MODY, but I'm thinking you are more along the lines of T2. The odd thing is the normal fasting glucose with such postprandial highs. Oh, have the endos ran an HbA1c? In case you don't know, that would be a three month average of your BG. My immediate suggestions, besides the new endo, would be to limit your carb intake as much as possible so you hopefully don't spike after meals. Let me know whats happening with you, and good luck.


My GTT results were as follows.

fasting 81 mg/dl
1 hour 299
2 hours 245
3 hours 102
4 hours 58
5 hours 81

My HbA1c is in the high normal range, and I don't have antibodies. I am thinking that MODY1 is a possibility. My maternal grandfather had this, the exact pattern, and my mother has it to a lesser degree (both undiagnosed). I just don't want to end up like my grandfather, who had early onset dementia as well as circulatory and gastrointestinal problems. I feel like I'm already on my way and I'm only in my early 40s. Thus my strong desire for some type of diagnosis and treatment.

So in your experience, that rapid rise in blood glucose, within the first hour, is not a typical Type II pattern? It just seems like there has to be something more to this than insulin resistance, given my normal fasting glucose and low fasting insulin.

Anyway, I really appreciate your help with this! I am calling yet another endo tomorrow. I will try to be assertive this time and ask specifically whether this could be something other than insulin resistance. I did mention this to the doctor before, but less directly, and never did get an answer.

No, the rapid increase in BG is normal for a T2. Your GTT follows the pattern consistent with T2, especially the early stages since you dropped to 58, but your BG spike reaches way higher than a prediabetic, which is up to 199 in the second hour. Above 200 usually confirms the diagnosis of diabetes (in the second hour). It looks like you are experiencing partially reactive hypoglycemia and partially diabetes. I still recommend you get more of a work up, since you clearly have a good amount of insulin resistance. I think you probably need to start on some meds to at least control your postprandial highs, and mention to an endo that you are having concerns. I'm surprised that the endos haven't taken this seriously.

I've been having a problem with severe cramping in my feet. It was so bad last night (usually happens when I'm in bed) that I could barely walk or flex my ankle joints. I just started taking Metformin about a week ago and I'm wondering if it could be a side effect of that (although I don't see that mentioned anywhere). Does anyone else have this, and should I be concerned since it is yet another new symptom? I should mention that I was recently diagnosed as being diabetic and have serious swings in blood sugar whenever I eat carbohydrates, but I do watch my diet closely. Thus, at the point, my blood sugar is fairly well controlled.