I think we have seen an increase in this pattern of OGTTs ie fasting
higher than the 2hour and I think we have often put it down to
"non-fasting". However recently there seems to have been in increase in
cases where the "2hr" is lower than the RR as in Phils case. The case
from Phil refers to an Indian gentleman and here in Bradford we have a
high Asian population. Is there any Dietary influence in the patterns??
The usual expectation is that if the patient has not had adequate
carbohydrate before the test then there can be a reduced Insulin
response to the carbohydrate but I wonder if there are Dietary
influences which can exagerate the Insulin response to an isolated
Glucose load almost akin to "Dumping syndrome". I intend to try and
collect some cases so any other comments would be appreciated.
David Robertshaw.
>>> Lester Geoff <[log in to unmask]> 16/03/06 07:59:50 >>>
Not sure whether that is a question about the "interpretative
comments"
thread or starting a new one about OGTTs.
Picking up the OGTT issue - we have seen a cluster of this pattern
recently
which, whilst I acknowledge it can occur, seems an unusually high
frequency
in the population investigated.
We can find no issue with the fluoride-oxalate tubes though have not
rigorously excluded them as the cause - and in any case you would
expect any
problem to be with the fasting sample that has hung around longer
before
they are analysed together. We did note that some bottles of the
Polycal we
use for the glucose load were cloudy rather than crystal clear. Our
pharmacy
have pursued this with the manufacturers but with no answer yet. Even
then I
cannot understand a possible mechanism for producing such low glucoses
even
if the "load" was low in glucose.
Has anyone else seen an increase in this phenomenon?
Anyone investigated it? And, even more significant, got a believable
explanation?
Our cluster seems now to have ended and we are currently seeing the
patterns
of GTT results we were used to.
Yours perplexed,
Geoff Lester
Consultant Biochemist
Royal Berkshire Hospital
-----Original Message-----
From: Wills Philip (Queen Elizabeth Hospital NHS Trust)
[mailto:[log in to unmask]]
Sent: 15 March 2006 16:08
To: [log in to unmask]
Subject: Interpretative comments
How about an interpretative comment on this one, a la a well
known national EQA scheme ,for those who cannot wait for the
next one.
"A 36 yo Indian gentleman goes to his GP for an unknown
reason where he is said to have 'a raised fasting glucose'
which is not on record at your laboratory. The clinical
details are '? DM'. He has an OGTT which shows a fasting
glucose of 5.0mmol/L and a 2-hour glucose of 2.1mmol/L. The
bloods were collected into fluoride/oxalate and results
confirmed. The patient was fit and well and showed no
symptoms at any stage.There were no other records on the
hospital system,nor could the GP add any information"
What would be your comment? What further tests would you
suggest?
**************************************************
This email and any files transmitted with it are confidential and
intended
solely for the use of the individual or entity to whom they are
addressed.
If you have received this email in error please inform the sender and
permanently delete the message and any attachments.
Recipients should be aware that all emails received and sent by this
Authority are subject to the Freedom of Information Act 2000 and
therefore
may be disclosed to a third party.
**************************************************
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
This message is confidential. It may also contain privileged information. The contents of this e-mail and any attachments are intended for the named addressee only. Unless you are the named addressee or authorised to receive the e-mail of the named addressee you may not disclose, use or copy the contents of the e-mail. If you are not the person for whom the message was intended, please notify the sender immediately at Bradford Teaching Hospitals NHS Foundation Trust and delete the material from your computer. You must not use the message for any other purpose, nor disclose its contents to any person other than the intended recipient. Bradford Teaching Hospitals NHS Foundation Trust does not accept responsibility for this message and any views or opinions contained in this e-mail are solely those of the author unless expressly stated otherwise.
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|