Dr. Amy Nett: That’s a great question. In this particular case, I generally use lactulose. I don’t use glucose a lot, but I would agree that if you have a diabetic patient whose blood sugar control you’re at all concerned about, I probably wouldn’t do the SIBO breath test if they don’t know if they can handle the 12 hours fasting or they don’t know how to adjust their medications for that. Certainly you don’t want to give a diabetic patient 100 grams of glucose if they aren’t really in tune with titrating their medication for such a situation, so you
probably just want to go with the other gut testing in that case.
Anthony is saying you cannot order lactulose if you don’t have prescription rights. OK. Yeah, so again, if you’re able to partner with a physician or if you have an MD or are otherwise able to find a way to do lactulose testing, that may be an option, but in terms of what you’re able to do at this time, I would be really reluctant to have a diabetic with unstable blood sugar control.
Laura actually just mentioned that Genova does a lactulose breath test. Anthony, I don’t know if you’re able to do the Genova lactulose breath test. Thank you, Laura.
Yeah, you know, all patients are individual, and this is why we certainly suggest what we consider somewhat of the optimal course, but you have to take these things into consideration. I actually have very few frankly diabetic patients. More often, I have prediabetic patients and they’re able to tolerate it.
Then Anthony answered, in the US, lactulose is a legend drug, as far as I can tell. So, Anthony, you’re saying that even the Genova lactulose test you’re not able to order? I’m not sure about that. Laura, I don’t know. You’ve had success ordering the lactulose test through Genova? That might be something that can be discussed a little bit further in the Facebook group, too, in terms of what some of the options are for ordering lactulose for people who have limitations in terms of prescribing.