Glucose tolerance test

 I had my WLS many years ago....I have now gained some of that weight back.
My doctor wants me to have a glucose tolerance test done as soon as possible.
I am scared because I dump on sugar.  But I have to have the test.
I'm not sure as to what to do...do I not have the test?
Any input would be greatly appreciated.

Penny - Holland MI

What surgery did you have??  My suggestion is to go on your specific board and ask that question.  I know the RNY board has recently talked about not having a 'normal' gtt done, but to have it modified somehow.  I just don't remember what it was :).

Good luck,

Edie

Hi,

I had my gastric bypass will be 8 years ago this coming Nov. 4th. I had RNY.... I am very Hypoglycemic...I have gained back approx 60 pounds from 118 to 178....It seems I have gained almost 10 pounds every year...mostly my fault.

But, to answer your question, my experience was this with a glucose tolerance test. I knew when I drank that sweet stuff they give you I was going to have a hypoglycemic reaction...So I told the people at the hospital to please get me a gurney because I know when it gets bad enough I go to sleep....  They did and I did...they would wake me every hour to draw more blood until I believe it was 3 hours and we were done. I had my husband come get me and take me home and I slept the rest of the day, of course with family waking me every hour to make sure I was ok....

Hope this helps.....

 

I had the test done for my pregnancy and I was only a year out of my RYN surgery.  I argued and fought with them telling them I didn't want to put myself through it that they had to have something else they could do they told me they had to have me do it.  So I sat in the waiting room dumping.  I got figity and my heart was racing, my face was turning red and I was burning hot.  Low and behold the test came back fine.  BUT I have been told there is a test they can do in its place I just don't know what it is.  The doctors just don't look into it!

DO NOT.... DO NOT .... DO NOT get a glucose tolerance test. The results will not be reliable and you'll scare the crap out of the technicians.  Seriously... it is not recommended that RNY folks get a glucose tolerance test. Don't do it. There are alternatives.

Basically they'll make you drink glucose -- about 50g to 100g of straight sugar.  So you'll dump.  Which means your blood glucose numbers will skyrocket into dangerous levels and they'll diagnose you as diabetic.  Then your blood glucose numbers will crash into dangerous levels... except during a tolerance test they don't test you soon enough, so by the time you get back to the lab to get tested you're so low that you could be in a coma by then.  And then they'll diagnose you with hypoglycemia.  So they'll be all sorts of confused because you are both diabetic and hypoglcemic... which isn't even possible.  So yeah, don't bother.

There's an article on Bariatric Times that is about pregnancy after RNY and talks about the glucose tolerance testing they recommend for all pregnant moms.  But give details about what the alternative is -- and gives a better picture of how our body reacts.  Basically it's a test after a high-carb meal rather than after drinking glucose.

Print a copy of this and take it to your doctor.

Here's the link and info:

http://bariatrictimes.com/2008/05/05/management-and-outcomes -of-pregnancy-following-bariatric-surgery/

Screening for gestational diabetes is recommended in all pregnancies; however, post-GBP patients may be unable to tolerate either the classic 50-gram glucose challenge or the 100-gram oral glucose tolerance test due to dumping syndrome. Dumping syndrome occurs because rapid gastric emptying of hyperosmolar contents directly into the small bowel after GBP leads to fluid shifts into the bowel lumen, resulting in distention.19 In early dumping syndrome, patients present with abdominal cramping, bloating, nausea, vomiting, and diarrhea. Later, a subsequent release of excessive insulin causes subsequent hypoglycemia. Therefore, late dumping syndrome patients present with tachycardia, palpitations, agitation, and diaphoresis.

Landsberger, et al., suggested using modified glucose testing. They recommend obtaining a fasting blood glucose level and a two-hour postprandial level after consuming the most carbohydrate-loaded breakfast the patient can tolerate.20 If fasting and two-hour postprandial glucose levels are less than 95mg/dL and 120mg/dL respectively, they are considered normal. Landsberger also recommends following hemoglobin, hematocrit, serum iron, ferritin, erythrocyte folate, methylmalonic acid, albumin, prealbumin, serum calcium, phosphate, and 25-hydroxy vitamin D levels. They assert that erythrocyte folate is a better indicator of true deficiency, whereas serum folate merely reflects recent oral intake, and that methylmalonic acid is more sensitive in detecting vitamin B12 deficiency. Finally, Wax, et al., recommend that second trimester maternal serum a-fetoprotein and ultrasound screening be offered, even if current data reflects that the risk of NTDs is theoretical.21
 

My OB wanted me to have the glucose test, too, while I was preggo.  It wasn't a fight with them, but I did have to explain to him and the nurses why I couldn't do it.  Instead, I did the Jelly Bean test (ate a certain number of jelly beans in 15 minutes and then was tested).  We discussed doing the high carb meal, too.  I forget why we went with the jelly bean test.    I told them that they wouldn't get reliable info with the traditional glucose test and gave them my research (I think it was an article or something I printed that you directed me to - indirectly...I think).  Anyway, they actually thanked me for the info because my OB hadn't dealt with an RNY patient before. 

Ok... so now that I got that other post out of the way.  What's going on with you?  What is making your doctor recommend the test?  If you give us your symptoms we might be able to help.  Is it hypoglycemia or is it just the weight gain you're facing?

 Thank you all for your replies on the glucose tolerance test.  I did not have the test.  My doctor is having me monitor myself here at home with a meter.

My symptoms are, weight gain, yeast infections, peeing alot, sweats, leg/feet cramps, tired and not feeling well after eating.

The weight gain is my fault, I stopped exercising.  No excuses.
I am having the scare of my life at this moment and I have started to get moving again.  No excuses!

I hope this info has helped.

Penny

When was the last time you had a full set of RNY labs?  Some of those symptoms might be related to a deficiency or two.  For instance leg cramps might be iron or Vitamin D deficiency. Fatigue could also be iron or B12 or a couple other B Vitamins. Peeing could be diabetes-related... have you had diabetes in the past? Are you have issues with blood sugar spikes and crashes? 

In case you need the list of labs... I've got it on my blog here
http://pamtremble.blogspot.com/2008/10/labwork-recommendations-after-wls.html

 Thanks so much Pam....the information is greatly appreciated.

My doctor does my labs and I have a Vitamin D deficiency and we have been addressing that.  The others you have mentioned are fine.  I looked at your site and saw that there were a couple of test that we were not doing and I am going to let him know.

As for the diabetes, I have had gestational 23 years ago and later before my WLS I had type one.

Thank you for the link to your web site I plan on using the spread sheets and the lab recommendations.

Penny