When you receive a diabetes diagnosis, it’s natural to assume that all your test results will clearly point in the same direction. But sometimes, they don’t, and that’s when things can feel confusing and frustrating.
This is exactly what happened to Taryn.
“My A1c was 6.0% in February, which I understood meant prediabetes. But my oral glucose tolerance test came back in the diabetic range. I felt like I’d skipped a step—from normal straight to type 2. It’s a label I’m struggling to accept.”
Taryn’s case is a great example of why the oral glucose tolerance test (OGTT) can play an important role in early diagnosis, even when A1c results appear less concerning.
Let’s unpack this.
The hemoglobin A1c (HbA1c) test reflects your average blood sugar levels over the past three months. It’s a useful, widely accepted tool for identifying prediabetes and type 2 diabetes, and it’s commonly used because it doesn’t require fasting or multiple blood draws. But it’s not a perfect test.
The OGTT, on the other hand, challenges your body with a concentrated glucose load. They will give you 75 grams of glucose in a sugary drink and then measures your blood sugar response two hours later. It specifically tests how well your body handles carbohydrate intake, making it a more sensitive marker of post-meal glucose spikes.
In Taryn’s case, her A1c of 6.0% sits in the prediabetes range, but her 2-hour OGTT result was 11.1 mmol/L (200 mg/dL) or higher, which meets the threshold for a type 2 diabetes diagnosis.
According to international guidelines, when two tests are conducted at the same time and one is in the diabetic range while the other is in the prediabetes blood sugar range, a diagnosis of type 2 diabetes is confirmed.
It might feel like Taryn skipped a stage, but what actually happened is this: the OGTT picked up on something the A1c missed.
And that’s not unusual. A1c can sometimes underestimate blood sugar problems, especially in the early stages, when post-meal glucose is the first to rise. That’s where the OGTT shines.
It’s particularly valuable for people who are not overweight or who appear healthy on the outside, because it can detect early carbohydrate intolerance even when fasting blood sugar and A1c look relatively normal.
The good news is that Taryn’s doctor was also right: this was caught early. Her A1c isn’t dramatically high, which suggests that while her glucose spikes are problematic, her average blood sugar hasn’t remained elevated long-term. That gives her a real opportunity to reverse type 2 diabetes with nutrition.
Choosing to hold off on medication like metformin and instead address it with diet and exercise is a valid option, especially when the condition is identified this early.
Of course, that decision should always be made with the support of your medical doctor, but knowing the rationale behind each test result can empower you to have those conversations with more confidence.
If you’re in a similar position, try not to feel defeated by the label. A diagnosis is not a life sentence, it’s an invitation to take action. And with the right tools, knowledge, and support, many people are able to bring their glucose levels back to a normal healthy range and remain medication free.
Keep asking questions. Keep advocating for yourself. And remember: your diagnosis does not define you, what you do next is what matters most.
👉 Listen to episode 87 of the Type 2 Diabetes Talk podcast where we talked about Amanda’s case study in more detail.
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