Atkins Diabetes Revolution by Robert C. Atkins Page B

glucose. (If glucose is found in the baseline urine sample, your doctor should check your fasting blood sugar before proceeding with the test.) It is then up to your doctor’s discretion whether to give you the glucose drink or proceed instead with a postprandial test—see page 71 for more on that. Assuming it is okay to proceed, you then drink a measured amount of a very sugary solution to test your body’s response over the next five hours.
    Here are the measurements Dr. Atkins would take during the glucose tolerance test:
    Here are the measurements Dr. Atkins would take during the glucose tolerance test:
     
T IME
B LOOD S UGAR
B LOOD I NSULIN
U RINE G LUCOSE
Fasting (start)
x
x
x
½ hour
x
1 hour
x
x
x
2 hours
x
x
x
3 hours
x

x
4 hours
x
5 hours
x
     
    Dr. Atkins would ask his patients to keep a journal noting any symptoms they experienced after drinking the glucose solution and the time the symptoms occur. Some people will feel fine during the test; most people do not. It is useful to be able to correlate symptoms with abnormal results on the test. He also found that charting symptoms can be an eye-opener for patients, helping them understand that the migraine headaches or intense irritability they may have experienced in the past can be related to an unstable blood sugar pattern.
    During the test,if the blood sugar goes too high early on,the patient may feel sleepy or nauseated, or have difficulty concentrating. Later, as the blood sugar drops too low or too fast, the patient may experience irritability, shakiness, palpitations, headache, anxiety, and numerous other symptoms. The more symptoms the patient has, the more carb intolerant he or she is,even if the blood sugar and insulin numbers are not yet way out of line. How you feel during the test is your window into your body and this silent illness.Your symptoms provide you with valuable information about the ups and downs in your insulin and blood sugar and how much stress these vacillations put on your body.
    Linda K. was obese and had severe and frequent migraine headaches. When Dr. Atkins gave her the GTT, her insulin was mildly elevated at the start of the test and went up very high as the test continued. Although her blood sugar levels didn’t rise above the normal levels, she reported typical symptoms. At the half-hour mark, for instance, she was lightheaded and had a headache. By the two-hour point, she still had those symptoms—but in addition she was now nauseated and jittery. By the fourth hour of the test, she had all the previous symptoms, plus irritability. The symptoms correlated with her rising insulin levels. When she started following the Atkins Nutritional Approach, she lost weight but, even better, her insulin normalized and she was free of her migraines as long as she continued to follow her individualized controlled-carb plan.
    WHAT THE GTT REVEALS
    Back in Chapter 2, the stages of insulin/blood sugar abnormalities that culminate in Type 2 diabetes. They’re important enough to bear repeating.
    The first four stages are milestones on the road to diabetes:
     
Insulin resistance of cells
Insulin resistance with hyperinsulinism (the production of large amounts of insulin)
Insulin resistance with hyperinsulinism and reactive hypoglycemia (low blood sugar)
Insulin resistance and hyperinsulinism with impaired glucose tolerance (prediabetes)
Type 2 diabetes with insulin resistance and high insulin production
Type 2 diabetes with low or virtually no insulin production
    The GTT is valuable because it reveals the earliest signs of hyperinsulinism, stage 2 on the six-stage continuum to diabetes. Insulin levels can be higher than normal even before the blood sugar becomes unstable enough to cause many symptoms.
    The case of Joe B. illustrates this point very clearly. Joe was 52 years old when he first came to see Dr. Atkins. At five feet seven inches, weighing 208 pounds, and with high blood pressure, he showed the classic signs of the metabolic