160 glucose in non diabetic, but normal OGTT

Patient

Q: 41 year old female, 5’10, 133 Ibs, no medications, active, no other medical problems, eat very healthy diet with no processed foods and very little sugar, Family history of diabetes in my Aunts. //Could high sugar be causing these spells of extreme fatigue and other symptoms? Can I still have Diabetes with a normal Oral Glucose Tolerance Test? I am honestly not sure where to go from here, since several of my tests have been normal or close to normal, but symptoms remain and I believe 160 is high for non-diabetic an hour after eating? I do not fit the mold for a diabetic being healthy weight and active, but we never found a cause for the retinal hemorrhages, cataracts, double vision, and damaged eye blood vessels back in 2011/2012? Could I be cycling between Hypoglycemia and Hyperglycemia and that is why I feel so terrible? My doctor currently has me monitoring with glucometer/finger prick monitor for the next month, but the 160 today concerned me a bit, is that normal and okay?

Symptoms:  Periods of extreme fatigue for years, Tingly hands, Hypoglycemia spells, Excessive hair shedding, Frequent urination at night, Occassional double vision spells 2011-2014, Retinal Hemorrhages in 2011 (normal EKG & Cardiac Ultrasound, normal brain MRI, normal sed rate, normal CBC w diff, normal blood chemistry, normal thyroid, normal homocysteine, normal CRP, normal ANA Screen, normal Protein S & C, normal Cardiolipin ABS, normal extensive autoimmune blood work, normal cholesterol, normal BP, HA1C 5.3 – all this blood work was done 2011), Many cataracts 2011-present, Damaged blood vessels in eyes seen during dilated eye exam in 2011 & 2012. My Doctor currently has me checking my sugar with Glucometer and it has been in the 90-115 range until last night when I began having one of my very sleepy spells, almost as if I had been sedated, felt terrible. Felt same way this morning after 10 hours sleep, could hardly move, took my sugar with the finger prick and it was 160 one hour after eating a bowl of organic oatmeal with tiny bit of honey. I double checked it a few minutes later and it was 158. After another hour (so 2 hours after eating) it was down to 98 and I feel a good bit better. I have had 2 high fasting glucose tolerance tests in last month (101 mcg/dL, and 105 mcg/dL with normal range being 70-100), and a normal Oral Glucose Tolerance Test (GLU GTT-FAST: 99 mg/dL, GLU GTT - 2HR: 84 mg/dL), also normal Insulin of 7.6 uIU/mL (range 2.6 - 24.9) all within the last month.
Doctor

A:   Hi.
Thanks for your query.
Read the very elucidate history.
To correlate well I will need all the relevant reports.
Please post the important reports so that we can discuss further in details and come to a conclusion which will help you further.
Awaiting ...

Comments / Follow Ups

Patient: I am unable to scan and upload that many documents, the file is too big. I listed every test above and noted results. Please just refund my money since you are unable to answer without reports.
Doctor: Not like that. It is not that I we can not answer without reports.
Your reports would have helped me to assist you more. As a Doctor there are certain things that are read in between the lines, that can be seen only on the actual reports and it is OK if you can not submit the bid file, I can see you have provided the reports well.
Do not get aggrieved. I have gone through all the things you have provided.
Your history to recapitulate: Female/41 - BMI of 19.8 (normal 18.5–24.9 ) - no medications - active - eat healthy - diabetes in Aunts - several tests normal or close to normal - but symptoms remain - never found a cause for the retinal hemorrhages, cataracts, double vision, and damaged eye blood vessels back in 2011/2012 - Sugar of 160 1 hour after eating is concerning for you - and have questions related to this and other things which we shall discuss further - normal Oral Glucose Tolerance Test - HA1C (Hb1Ac) is 5.3 (less than 6) -Read all the reports you have posted above -

My thoughts and answers to your questions with possible explanations:

Could high sugar be causing these spells of extreme fatigue and other symptoms?
> Very high blood sugars of more than 300+ can only cause fatigue and none of your readings must have gone so high, I am sure. There must be other reasons of fatigue. High stress and/or anxiety can cause these spells of fatigue, or there may be other causes.

Can I still have Diabetes with a normal Oral Glucose Tolerance Test?
> Normal oral glucose tolerance indicates that you are not diabetic.

I am honestly not sure where to go from here, since several of my tests have been normal or close to normal, but symptoms remain.
> First of all stop worrying. The stress and strain and the anxiety in particular are one of the commonest reasons for most of the medical problems which are not explained by the routine tests and so on. Hence the Basic search remains to be seen to find the cause.
In medical jargon (terminology), the condition where the causes could not be found in spite of the extensive tests and research is called ''idiopathc''. There are still many diseases and disorders that are still idiopathic in spite of all the great advances in the medical field and so on. So I would advise you to take a second opinion of another Ophthalmologist for your eye problems.

**and I believe 160 is high for non-diabetic an hour after eating?
> The commonest reason for increased blood sugar is the increased stress and/or anxiety. In old times the diseases of diabetes and hypertension were called ''Executive diseases'' meaning that only the people with the high stress/'anxiety used to get such problems.
Hence getting a few reading of blood sugar high in spite of normal oral glucose tolerance and Hb1Ac is likely and not to be worried about at all. (I hope the message is clear to you, if not please ask relevant further queries.)

**but we never found a cause for the retinal hemorrhages, cataracts, double vision, and damaged eye blood vessels back in 2011/2012?
> This is called idiopathic where the causes are not found or could be correlated.

Could I be cycling between Hypoglycemia and Hyperglycemia and that is why I feel so terrible?
> There is no condition to have such a problem, hence I do not not agree the cyclic nature of hypo and hypergltcemia.

** but the 160 today concerned me a bit, is that normal and okay?
> We get many patients with the reading of elevated blood sugar as you have and always fond them to be non-diabetic in consecutive studies.
Hence I would advise you the following:
- To get an opinion of another Ophthalmologist, preferably a senior one and who is dealing with the problems.
- Not to worry about the diabetic status as you are not and few high readings do not label you to have diabetes since your Hb1Ac is normal. It shows your sugar control over the past * 3 months.

I hope this answer helps you a bit.
Please feel free to ask for further relevant queries if you need to or if you feel that there is a gap of communication.

Let us discuss further till you are satisfied.
Take care.

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