I have to tell you, for many, reactive hypoglycemia is a harbinger of diabetes. You normally have two sources of insulin (Phase 1 and 2). You actually store insulin and release it when eating. This is called your phase 1 response. Then you can produce insulin and just dump it (instead of storing it), that is the phase 2 response. In a non-diabetic, they can eat something and the phase 1 response can release all the insulin that is needed and even if you eat 20 Twinkies (which you can no longer do since they went out of business) your blood sugar will hardly move.
Now, diabetes rears it's ugly head. Your body becomes insulin resistant and/or you don't produce enough insulin and all the sudden the phase 1 response is really poor and you are left with only a phase 2 response to deal with meals. Unfortunately, the phase 2 response is slow, weak and sluggish, so you go high after a meal and then finally when you start producing enough insulin, you overshoot and that is what causes a low. While some individuals have other conditions that cause reactive hypoglycemia, I am pretty confident your problem is diabetes. You can deal with reactive hypoglycemia with a low carb diet and significantly reduce the effect.
And unfortunately, I have to back up what others have said. When your blood sugar is > 200 mg/dl 2 hours into the OGTT, that is diabetes. Not pre-diabetes. Definitive clinical diagnosis of diabetes. And while your A1c and fasting glucose may well be fine, it is important to understand they are "lagging" indicators of your diabetes. The OGTT is perhaps the most sensitive test for diabetes, it really shows how our bodies react to meals. The OGTT is usually the first indication of diabetes. And when your blood sugar is still high after 2 hours and starts to get constantly high all the time, your body cannot even lower your blood sugar between meals and you fasting blood sugar and A1c rise. But they only rise after things have gotten really bad. So while diabetes is a devastating thing to have, you have it early and prompt action can really address the situation.
ps. I also suffer from sleep apnea, which not only causes me to feel tired (cause I wake up all the time), but it also is a high risk factor for diabetes. I am not being treated for the apnea.
Did you do a full panel? GAD is only the most common LADA antibody. Melitta has posted the full list...somewhere around here!
Here is what she wrote: "Hi Robin: I would ask to see the actual results of the antibody testing. Was the full suite run? Too often, doctors only order GAD, when GAD, ICA, IA-2, and zinc transporter all should be run. Don't just take the doctor's word for it, ask to see the actual lab results"
Hi Robin: It's important to run the full suite of antibody tests because, although GAD is the most common, a high percentage of people with adult-onset Type 1 diabetes are only ICA positive. So I think it is worthwhile to get the full suite of testing and insist on seeing the actual lab results.
Oh, Robin, I'm so sorry that you sound just like me!
I was diagnosed with reactive hypoglycemia at 16 because my father has it, too. Simple diagnosis, simple treatment (low carb), right? Wrong. Though I had a "normal" OGTT, within 6 months I started to see highs. They've gotten worse over the years and when I started to spike to near 200 on a regular basis (almost always falling below 140 by the 2 hour mark, but this happened several times a day), my endo decided it was an enzyme deficiency and pulled me off of grains, which helped some. (I think that's because I'm not eating many carbs at this point.)
Have you had a c-peptide done? What about an insulin level? Those are important to see whether you're insulin resistant or low on insulin. My c-peptide is 9.7, where the normal range is between 2 and 4. I'm young and thin and active and eat well--no way I'm THAT insulin resistant. I'm going to bring that up with my endo when I see him at the end of February.
I've heard of reactive hypoglycemia being the extremely early stages of LADA (and yes, sometimes if it's very early those tests may not come back positive for LADA), but I've also heard of it being the early stages of T2. I personally have had 2 reactive hypos in the last few weeks but otherwise haven't had them for months. What everyone has said about over-compensation by the pancreas for high blood sugar is absolutely true, and I have the stories to prove it.
My family also has some autoimmune floating around in it, but I have more immune issues than everyone in my family put together. Yay for me! My antibodies (as of the summer of 2011) are also normal. Go figure.
As far as being tired is concerned, there could be a few things at play. One could easily be Hashimoto's disease (autoimmune low thyroid), which I happen to have and would fit in with your family's history of autoimmune. Another could be that interrupted sleep you were talking about--interrupted sleep is pretty exhausting. A third could be the blood sugar swings. On any given day, if I've been low or high, I'm usually left with a pretty bad migraine and exhaustion that doesn't go away even after I treat the migraine. The worst are days when the differences in BG could stand as blood sugars on their own (like a day I had last week where I was 174 and then 63 an hour later--that's a difference of 111 mg/dl, which could stand by itself as a rather nice blood sugar).
Finally, an A1c will only show highs or lows if you spend a significant amount of time there. Being 275 2 hours after a meal sounds pretty high, but if it happens once a day and let's say you drop within the hour, that's 3 hours of being high and 21 hours of being normal--so that's only about 13% of your day being high. Though that can certainly make you miserable, it won't have a large impact on your A1c, especially if you hang out under 120 for the rest of the day. My A1c is also normal--I think my latest was 5.1, despite the fact that I was seeing multiple highs above 160 every day for months before it was drawn.
I wish you the best of luck, and may you search for answers for less time than I have!
RobinA,I would get a second opinion. Do you need a referral from your PCP to see someone else? You may like this doctor personally, but we are talking about your health here. He may not be concerned about it, but it is YOUR body.Losing weight, high blood sugars and uncomfortable symptoms are NOT normal for a non-diabetic!! I would try to go to a state-run University-based endocrinology clinic. Many of them have a reduced payment scale if your insurance coverage is limited.
I would say your doctor is right and you can have both reactive hypoglycemia and diabetes at the same time. As a result I would treat you as if you had both. Usually reactive hypoglycemia is a precursor to diabetes so you don't want to ignore it. Since your 2 hour number at the 2 hour mark was so high I would definitely agree with your doctor about the diabetes and you don't want to ignore that.