Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Though not routinely used anymore,
the oral glucose tolerance test (OGTT) is the gold standard for making the
diagnosis of type 2 diabetes. It is still commonly used for diagnosing
gestational diabetes. With an oral glucose tolerance test, the person fasts
overnight (at least 8 but not more than 16 hours). Then first, the fasting
plasma glucose is tested. After this test, the person receives 75 grams of
glucose (100 grams for pregnant women). There are several methods
employed by obstetricians to do this test, but the one described here is
standard. Usually, the glucose is in a sweet-tasting liquid that the person
drinks. Blood samples are taken up to four times to measure the blood glucose.
How reliable is the glucose tolerance test?
For the glucose tolerance test to give reliable results, the person must
be in good health (not have any other illnesses, not even a
cold). Also, the person should be normally
active (not lying down, for example, as an inpatient in a hospital) and should
not be taking medicines that could affect the blood glucose. For three days before
the test, the person should have eaten a diet high in carbohydrates (150- 200
grams per day). The morning of the test, the person should not
smoke or drink
coffee.
What does the glucose tolerance test measure?
The classic oral glucose tolerance test measures blood glucose levels five times
over a period of 3 hours. Some physicians simply get a baseline blood sample
followed by a sample 2 hours after drinking the glucose solution. In a person
without diabetes, the glucose levels rise and then fall quickly. In someone with
diabetes, glucose levels rise higher than normal and fail to come back down as
fast.
People with glucose levels between normal and diabetic
have impaired glucose tolerance (IGT). People with impaired glucose tolerance do not have diabetes.
Each year, 1%-5% of people whose test results show impaired glucose tolerance actually develop diabetes.
Weight loss and exercise may help people with impaired glucose tolerance return their glucose levels to
normal. In addition, some physicians advocate the use of medications, such as
metformin (Glucophage), to help prevent/delay the onset of overt diabetes.
Recent studies have shown that impaired glucose tolerance itself may be a risk factor for the
development of heart disease, and
whether impaired glucose tolerance turns out to be an entity that deserves treatment itself is
something that physicians are currently debating.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
The risks for developing type 2 diabetes include family history, ethnicity, birth weight, metabolic syndrome, and obesity. Warning signs pointing to an increased risk for developing type 2 diabetes include irregular menstruation, impaired fasting glucose, inflammatory markers, and other risks. Gestational diabetes is also a risk factor for developing type 2 diabetes later in life. Prevention of type 2 diabetes can be achieved through a healthy diet (Mediterranean diet), exercise, weight control, not smoking, and medication.
Managing your diabetes is important. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information is also provided in this article.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
Taking care of a disease such as diabetes is a life-long process. Learn how to care for yourself or loved one with diabetes in situations such as illness, work, school, travel, or a natural disaster.
The major goal in treating diabetes is to minimize any elevation of blood
sugar (glucose) without causing abnormally low levels of blood sugar. Type 1
diabetes is treated with insulin, exercise, and a
diabetic diet. Type 2 diabetes
is treated first with weight reduction, a diabetic diet, and exercise. When
these measures fail to control the elevated blood sugars, oral medications are
used. If oral medications are still insufficient, treatment with insulin is
considered.
Adherence to a diabetic diet is an important aspect of controlling elevated
blood sugar in patients with diabetes. The American Diabetes Association (ADA)
has provided guidelines for a diabetic diet. The ADA diet is a balanced,
nutritious diet that is low in fat, cholesterol, and simple sugars. The total
daily calories are evenly divided into three meals. In the past two years, the
ADA has lifted the absolute ban on simple sugars. Small amounts of si...
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