A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. The test is usually used to test for diabetes, insulin resistance, and sometimes reactive hypoglycemia. The glucose is most often given orally so the common test is technically an oral glucose tolerance test (OGTT). Glucose (Glc), a monosaccharide, is one of the most important carbohydrates. ... For the disease characterised by excretion of large amounts of severely diluted urine, see diabetes insipidus. ... In medicine, insulin resistance denotes a decompensation of glucose homeostasis where the tissues appear to be less responsive to insulin. ... Reactive hypoglycemia is a medical term describing recurrent episodes of hypoglycemia occurring 2-4 hours after a high carbohydrate meal (or oral glucose load). ...

Preparation and cautions

The patient is instructed not to restrict carbohydrate intake in the days or weeks before the test. The test should not be done during an illness, as results may not reflect the patient's glucose metabolism when healthy. A full adult dose should not be given to a person weighing less than 43 kg (94 lbs), or exaggerated glucoses may produce a false positive result. Carbohydrates are chemical compounds that contain oxygen, hydrogen, and carbon atoms. ... A false positive, also called false alarm, exists when a test reports, incorrectly, that it has found a signal where none exists in reality. ...

Procedure for OGTT

The patient should have been fasting for the previous 8-14 hours.

A zero time (baseline) blood sample is drawn.

The patient is given a glucose solution to drink. The standard dose since the late 1970s has been 1.75 grams of glucose per kilogram of body weight, to a maximum dose of 75 g. It should be drunk within 5 minutes. Prior to 1975 a dose of 100 g was often used. ...

Blood is drawn at intervals for measurement of glucose (blood sugar), and sometimes insulin levels. The intervals and number of samples vary according to the purpose of the test. For simple diabetes screening, the most important sample is the 2 hour sample and the 0 and 2 hour samples may be the only ones collected. In research settings, samples are may be taken on many different time schedules. Glucose (Glc), a monosaccharide, is one of the most important carbohydrates. ... In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... The structure of insulin Red: carbon; green: oxygen; blue: nitrogen; pink: sulfur. ...

Interpretation of OGTT results

Fasting glucose should be below 100 mg/dl. Fasting levels between 100 and 126 are borderline ("impaired fasting glucose"), and fasting levels repeatedly above 125 are diagnostic of diabetes. The 2 hour glucose should be below 140 mg/dl. Levels between 140 and 200 indicate "impaired glucose tolerance." Glucose above 200 at 2 hours confirms a diagnosis of diabetes.

In Europe, blood glucose is measured in mmol/l. 1 mmol/l=18 mg/dl. For the values above, 110 mg/dl=6.2 mmol/l, and 125=7, 140=7.8, 200=11.1.

Variations

A standard 2 hour OGTT is sufficient to diagnose or exclude all forms of diabetes mellitus at all but the earliest stages of development. Longer tests have been used for a variety of other purposes, such as detecting reactive hypoglycemia or defining subsets of hypothalamic obesity. Insulin levels are sometimes measured to detect insulin resistance or deficiency.

The OGTT is of limited value in the diagnosis of reactive hypoglycemia, since (1) normal levels do not preclude the diagnosis, (2) abnormal levels do not prove that the patient's other symptoms are related to a demonstrated atypical OGTT, and (3) many people without symptoms of reactive hypoglycemia may have the late low glucoses that are said to be characteristic. Using a glucose tolerance in this context resembles use of a Rorschach test in that it is often used to support a diagnosis that the patient and doctor are already reaching agreement on based on other evidence, but it is inadequate by itself to confirm or refute the diagnosis (unlike its use for diabetes).

When the glucose is given intravenously it is termed an intravenous glucose tolerance test (IVGTT). This has been used in the investigation of early insulin secretion abnormalities in prediabetic states.