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Medical Forum / Diseases and Disorders / Diabetes / March 2006Doc today
No revelations, but this one is clearly better than my old one. His "quick exam" was a lot more thorough than my annual physical with the old one ever was. Found out by googling him this AM that he's one of the associate professors at the med school at our local university. The shakes connected to the bg swings he termed "reactive functional hypoglycemia", no surprise there. He said to keep doing what I'm doing as best I can and try to get the weight off, and that I've probably had it for awhile but have been medicating it by eating (ergo my weight). He thinks that the shakes and bad feelings that don't correlate to the meter are one of 3 things: 1) a serotonin system gone berserk because of the change in body chemistry from the diet (serotonin syndrome can cause heat waves, shakes, and dry mouth but is usually more severe). 2) adrenal glands gone beserk either from the diet change or just because they're beserk. 3) menopause showing up that way He wants to see me again in 2 months, wants another set of labs done before he sees me. He's hoping the whole mess settles down but if it doesn't then he'll have the labs to look at. At least he listened to me and didn't try to blow off what was going on or escape from the room while I was talking like the other one. And he asked decent questions. LQ Oh, and I asked him about a GTT and he said that it wasn't needed as my logs showed him what was going on, and that the fasting bg was, in his opinion, sufficient to determine diabetes and that I wasn't there yet. And I also asked him about metformin for the IR but he said that I wasn't there yet either. It did leave me wondering how bad I have to be to "be there". LQ > Oh, and I asked him about a GTT and he said that it wasn't needed as my > logs showed him what was going on, and that the fasting bg was, in his > opinion, sufficient to determine diabetes and that I wasn't there yet. He sounded really good til this. I have been diabetic for years, and have never had a fasting bg in the diabetic range. Jenny has posted research indicating that this is more typical than not. At least he didn't blow you off, and it sounds as if he put significant thought into assessing the possibilities, so those are pluses that indicate you should be able to work with him. > And I also asked him about metformin for the IR but he said that I > wasn't there yet either. Yeah, your numbers aren't that bad; diet and exercise should do it. > It did leave me wondering how bad I have to be to "be there". Don't count on a fasting test to tell you; that's what your meter is for. Susan Yeah, it did make me wonder about anyone he saw who had bad postprandials but a normal fbg. He did ask me how high mine have gone (max has been 162 after those cinnamon hearts on an empty stomach but they were only up there for 10 minutes) and how low I've gone (67, sometime last week). That was more than the other one did. LQ > Yeah, it did make me wonder about anyone he saw who had bad > postprandials but a normal fbg. He wouldn't know it, docs don't test or ask about post prandials. They've been trained to use FBG for screening. > He did ask me how high mine have gone (max has been 162 after those > cinnamon hearts on an empty stomach but they were only up there for 10 > minutes) and how low I've gone (67, sometime last week). That was more > than the other one did. So far, he sounds like he's assessing you carefully, allowing your body time to cycle the whole endocrine feedback loop (3 mos) to see where you're at. It's what I would want from a doc at this point. Cleansing breath! :-) Susan > x-no-archive: yes > [quoted text clipped - 3 lines] > He wouldn't know it, docs don't test or ask about post prandials. > They've been trained to use FBG for screening. That's changing. My GP used to focus only on FBG, but now she asks about 2hr PP as well.  SignatureAF "Non Sequitur U has a really, really lousy debate team." --artyw raises the bar on rec.sport.baseball >>x-no-archive: yes >> [quoted text clipped - 6 lines] > That's changing. My GP used to focus only on FBG, but now she asks about > 2hr PP as well. I'm glad to hear it happened in a medical office to you, but I've never heard it happening in a primary care office before. Not saying it can't happen, just that one case doesn't mean the fbg standard for screening has changed. Susan > x-no-archive: yes >>>x-no-archive: yes >>> [quoted text clipped - 6 lines] >> That's changing. My GP used to focus only on FBG, but now she asks about >> 2hr PP as well. > I'm glad to hear it happened in a medical office to you, but I've never > heard it happening in a primary care office before. Not saying it can't > happen, just that one case doesn't mean the fbg standard for screening > has changed. I was lucky (UK NHS GP) that my doctor had just come back from a conference on the metabolic syndrome, prediabetes, etc., when I turned up and showed him the graph of the GTT I had carried out on myself. Well, it wasn't glucose, it was actually a muesli tolerance test, because at the time a bowl of muesli was my preferred breakfast, but the BG of over 200 at one hour suggested what kind of results a GTT would have returned. He told me that having just come from this conference he fully agreed with my suspicions, but pointed out that the formal NHS guidelines he was obliged to follow for official diabetes diagnosis were a bit out of date. So he prescribed a big pile of test strips and asked if he could keep my graphs for inclusion in my file. SignatureChris Malcolm cam@infirmatics.ed.ac.uk +44 (0)131 651 3445 DoD #205 IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK [http://www.dai.ed.ac.uk/homes/cam/] > Yeah, it did make me wonder about anyone he saw who had bad > postprandials but a normal fbg. Given the numbers you are posting, you have definitely impaired glucose function. That can be treated in the same way as if you have diabetes already. The little and often approach for the RH can still fit in with a diabetic plan. There is sometimes an overlap of RH and diabetes at the beginning but you are not going to progress to diabetes, are you ;) > but you are not going to progress to diabetes, are you ;) I sure as hell hope not, after everything I've been doing and going through that would really piss me off. My goal is to get back to near-normal glucose tolerance. Lofty, maybe, but the post-bariatric surgery patients recovering first phase and other stories of people regaining nearly-normal glucose tolerance after a lot of work give me hope. For some there appears to be some sort of pancreatic repair mechanism going on, I just hope I started getting my act together in time for it to still be there and do some good. I really can't face going through this thinking that the best I'll ever be able to achieve is this current state of miserable living with RH. I am about 60 lbs overweight, which will be coming off come hell or high water. Hopefully that will be enough, plus resting the pancreas as much as possible by a) low carb and b) not eating ;) will give it a fighting chance. In retrospect I'm amazed that it didn't give out sooner. I didn't realize how many empty carbs I had been eating until I had to cut them way back because of this. It gives me hope that maybe my pancreas is strong enough to repair itself if treated a lot better. LQ > x-no-archive: yes > >> Oh, and I asked him about a GTT and he said that it wasn't needed as >> my logs showed him what was going on, and that the fasting bg was, >> in his opinion, sufficient to determine diabetes and that I wasn't >> there yet. > > He sounded really good til this. I have been diabetic for years, and > have never had a fasting bg in the diabetic range. Jenny has posted > research indicating that this is more typical than not. There are cites to this and I saw them only in the past few days. It was something to the effect that postprandials were often higher long before fasting bg's started to rise. I was the opposite in actual fact. Fastings hit diabetic range first, I went for the GTT and it was only after the glucose that I showed high pp's. Normal pp testing with my food didn't indicate that. Here we are, this is just one cite, I am sure there are more: http://www.aafp.org/afp/20040415/1961.html "The first glucose abnormality that is detected is a rise in the postprandial glucose levels because of reduced first-phase insulin secretion. With time, further decline in beta-cell function leads to elevation of the fasting glucose levels. Eventually, diabetes occurs, with more insulin secretory loss." : x-no-archive: yes : > Oh, and I asked him about a GTT and he said that it wasn't needed as my : > logs showed him what was going on, and that the fasting bg was, in his : > opinion, sufficient to determine diabetes and that I wasn't there yet. : He sounded really good til this. I have been diabetic for years, and : have never had a fasting bg in the diabetic range. Jenny has posted : research indicating that this is more typical than not. : At least he didn't blow you off, and it sounds as if he put significant : thought into assessing the possibilities, so those are pluses that : indicate you should be able to work with him. : > And I also asked him about metformin for the IR but he said that I : > wasn't there yet either. : Yeah, your numbers aren't that bad; diet and exercise should do it. : > It did leave me wondering how bad I have to be to "be there". : Don't count on a fasting test to tell you; that's what your meter is for. : Susan Since you are not "there" yet, make sure your health insurance and any other life insurance is in good order. Once yu are diagnosed as "there" yu will have trouble getting both life an health insurance and, if yu do get it, it will cost much more. Wendy > : > Oh, and I asked him about a GTT and he said that it wasn't needed as my > : > logs showed him what was going on, and that the fasting bg was, in his > : > opinion, sufficient to determine diabetes and that I wasn't there yet. > Since you are not "there" yet, make sure your health insurance and any > other life insurance is in good order. Once yu are diagnosed as "there" > yu will have trouble getting both life an health insurance and, if yu do > get it, it will cost much more. On the other hand, after diagnosis you can purchase an annuity at a cheaper rate because they don't think you'll last as long. Every cloud has a silver lining :-) SignatureChris Malcolm cam@infirmatics.ed.ac.uk +44 (0)131 651 3445 DoD #205 IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK [http://www.dai.ed.ac.uk/homes/cam/] > And I also asked him about metformin for the IR but he said that I > wasn't there yet either. > > It did leave me wondering how bad I have to be to "be there". Yeah, I wonder what his reasoning is? Still, he sounds pretty good otherwise. Glad you found him! Nicky. SignatureA1c 10.5/5.4/<6 T2 DX 05/2004 1g Metformin, 100ug Thyroxine 95/74/72Kg That's a start. I hope you're feeling better after seeing the doc, and not quite as worried. -- Cheri LizardQueen wrote in message <1141860691.995233.57050@v46g2000cwv.googlegroups.com>... >No revelations, but this one is clearly better than my old one. His >"quick exam" was a lot more thorough than my annual physical with the >old one ever was. >That's a start. I hope you're feeling better after seeing the doc, and >not quite as worried. Well, I should think you have some considerable basis for being cautiously optimistic. I would suggest you do exactly as your doctor advises, to the extent you can, and watch your monitor like a hawk! Good luck. Will, T2 LQ, Your new doctor sounds much more attentive. Good! And while I know you're feeling really rough and want a quick solution, I applaud his wait and see approach. If one of your systems is has "gone beserk", it seems logical to give it a chance to right itself before adding a medication to the mix. Hopefully, you'll eventually be able to control your symptomology through diet, exercise, and weight loss. In the meantime, it doesn't sound as if you need to stress yourself with "what ifs". Do what you know you need to do and try to think calm thoughts. Michelle |
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