I was about to launch off in a review about an article I read online at the American Diabetes Association regarding two diagnostic tests for diabetes.  But then I realized that it may be more important to give you a bit of a description of the tests before I go spouting off my opinion of the article.  So here goes…

The Oral Glucose Tolerance Test, OGTT, has been used as the primary diagnostic of Type 2 diabetes as well as some of the Type Others of diabetes like CFRD, (once again, CFRD is not Type 1 OR Type 2 we are Type Other go look it up on the wikipedia!).  The OGTT is time consuming and fairly painless.  Like it says, the test is done by intaking glucose oraly and they test your tolerance to it.  In other words they take a few blood draws (or fingersticks) before and after you drink something like orange soda and see how your body reacts to the sugars.  If it doesn’t react properly, then the finger points to diabetes.

Getting ready for the test… Don’t eat or drink from midnight the night before, they say 8-14 hours.  I am not sure if black coffee is ok, but it seems like caffeine has different reactions to blood sugar levels in different people, so if I were you having this test I’d drink water and only water.

Next, you show up at the doctor where they sit you down hopefully in front of a TV because this test takes two hours of basically just sitting there.  Some doctors (or nurses) use a small IV to draw blood, so they don’t have to stick you mulitple times.  Others use a finger stick blood glucose meter, which you just better learn to deal with if the test comes up positive (I have to use my fingerstick thingy 4-8 times a day, sometimes more).  I had my OGT test 7 years ago, and I think they used the fingerstick method… but my memory escapes me.  …The nurse sits you down and draws a fasting level which will show what your blood sugar level is when you have no food in your system.  This alone can be enough to diagnose someone with diabetes (as it was for me).  If your pancreas does not make enough insulin to regulate the sugars normally produced in your body, even without food, more than likely you have da ‘betes, they call that fasting hyperglycemia.  Pretty much, if you have fasting hyperglycemia, you have diabetes.

As a quick note, to explain how insulin works simply, it is like a key that unlocks the cells and allows them to take in the sugar (ie glucose) and turn it into or store it as energy to use in the future.  Without insulin (made by your pancreas or by supplemental shots) it is not possible to change the nutrients into energy.  Basically put.  Without insulin, sugar builds up in your blood which wrecks your blood vessels and does some other nasty stuff.

So… back to the test.  After they draw a fasting blood glucose level, they hand you a bottle of this sickening sweet drink that is like a flat orange soda with a little extra sugar added.  If they are nice enough, they will have refridgerated it for you which helps it go down a lot easier.  (Ooh! If you are going for this test you could make a funny out of it and bring in a swirly straw and a drink umbrella!!!  Bet the nurses would be a little nicer when they stick you for blood! Wish I would have thought about that before! hehe!)  Back to the matter…  I have heard a lot of folks complain about how sweet that drink is.  But to me, when my body wasn’t absorbing enough energy from (not enough insulin to do so) I craved sweets and other carbs night and day, the warm flat sugary soda tasted so yummy.  For those of you number crunchers, the “soda” has 75 grams of carbs in it.  Regular orange soda has 35 grams in one cup… so it really isn’t much sweeter than two cups of the real thing.

At 30 minute intervals they test the level of sugar in your blood until the 2-hour mark.  They should be able to tell you right then and there what the number is.  I stole the following data off of the American Diabetes Association website it is in reference for ANYone testing for diabetes, no matter what Type (and are also used for the diagnosis of CFRD):

Fasting Levels:
Normal Fasting <100 mg/dl (mg/dl is the unit measure used in the US and what would be shown on your fingerstick meter if you are using one)
Pre-diabetes Fasting <125 mg/dl
Diabetes diagnosis Fasting >126 mg/dl
For me, I was above 126 fasting, so we already knew at that point I was screwed.

At the two-hour mark:
Normal <140 mg/dl
Pre-diabetes 140 to 199 mg/dl
Diabetes diagnosis 200+ mg/dl  (which I hit at the first 30 minute mark)

If you really are concerned and your doctor is not listening to you, you could try the test at home if you have a meter and some decaffeinated soda (doesn’t have to be orange flavor, I would prefer grape or strawberry… ooh! or Squirt!).  Make sure you do the test in the morning though because your body makes natural steroids throughout the day which will affect your numbers.  But still, if you do the test at home, it is not an official diagnosis, but it may put your mind at ease if it’s negative and you have been worrying.  Oh! And make sure you are not taking steroids or sick.  Those two can really throw off your results.

I have been quite frustrated and disillusioned by what some of my fellow cystics have said to me.  They have shown interest in getting the test done because they are showing signs of CFRD and they want to take a proactive role in taking care of their health.  Some of their doctors say, “nah, you don’t really need it” or “go to your primary care physicain”… do these doctors have no clue in how untreated diabetes affects your health? especially your CF health?!!  I just want to shake those doctors.  It’s a simple test which could save someone a lot of pain and suffering.  Untreated and uncontrolled diabetes makes you MUCH more prone to infection, which is a cystic’s worst nightmare!  Not to mention all the other crud that comes along with it….  Come on doc’s get with the program and TEST YOUR PATIENTS!  Personally, I go with the CFF (Cystic Fibrosis Foundation) guidelines as a baseline, more can be done, but less is just irresponsible. The CFF suggests that anyone (with CF of course) who is pancreatic insufficient (takes enzymes) be tested (via OGTT) every year after the age of 12 if they show signs or symptoms.  Some docs think the A1C test is enough… but I’ll get into that later.  Next post will be about the A1C test.

Hmmm… well I think that sums up the oral glucose tolerance test.  Any questions?