4
Assessment
Second Level Tests (consider for higher risk groups)
• 75 or 100 gram oral glucose tolerance test (OGTT)
• Postprandial glucose and insulin tests
▶ with or without insulin test
• Advanced lipid profile to provide LDL particle size and number (large size
and small number are desirable)
• Coronary artery calcium (CAC) score to quantify coronary artery disease
• Serum uric acid
• Serum ferritin for iron stores (especially if vegetarian, low red meat
consumption, or status post gastric bypass)
• Vitamin B12 (especially if vegetarian, on long-term metformin use, or status
post gastric surgery)
• Vitamin D (especially if status post gastric surgery)
• High-sensitivity C-reactive protein (hsCRP) to check systemic inflammation
• C-peptide levels (consider for patients who have been on long-term insulin
to ensure that the patient is still making insulin, especially if the patient
does not fit the typical pattern of hyperinsulinemia)
• Body composition scale that can accurately estimate visceral fat
Continuous Glucose Monitor (CGM)
• CGM technology has become more accessible, affordable, and user friendly
over time.
• Reactive hypoglycemia and large post-meal spikes are common with
standard high carbohydrate dietary patterns, both in insulin resistance
and in later stage T2D with beta cell insufficiency. The CGM shows these
patterns and how an individualized nutrition regimen improves them.
Patient Selection
• Patients are good candidates for some type of carbohydrate-restricted
dietary intervention if they have a problem with overweight, obesity or
another metabolic problem.
• Patients should be able and prepared to use a blood glucometer to check serum
glucose if on insulin or insulin secretagogues (sulfonylureas and meglitinides)
and to communicate with the health care team during the dietary intervention.
• In most cases, patients with an acute, unstable medical condition are not
candidates for any dietary intervention.
• Co-existing conditions such as pregnancy or kidney or liver disease may
require additional dietary changes or even interdict certain regimens.
