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Medical Forum / General / Laboratory / October 2008Non-diabetic w/ a fasting blood glucose of 37 mg/dL
I'm a non-diabetic w/ a fasting blood glucose of 37 mg/dL, and tremors, ataxia --which could be neurological as well--, restlessness, and occasional dizziness. My FP says just eat more, but I drink enough sugar through out the day to be hyperglycemic. Do I need a C-peptide test? Thanks!!! >I'm a non-diabetic w/ a fasting blood glucose of 37 mg/dL, and >tremors, ataxia --which could be neurological as well--, restlessness, >and occasional dizziness. My FP says just eat more, but I drink enough >sugar through out the day to be hyperglycemic. Drinking "sugar through out the day" is not good for you. Drink less sugar, and eat some real food. If you just add food, you will gain too much weight. Cut the sugar drinks, eat food. You will magically be fine! :-) Try it, at least you will be better nourished. bob If you had a glucose of 37 you'd probably be passed out. Then they would take you to the ER and would perform glucose testing. They would probably refer you to an endocrinologist. They might keep you overnight if your electrolytes were out of whack also. They might do some scans if tumors were suspected, although I'm not sure how they determine the presence of tumors on islet cells of the pancreas. Are you making up stuff again Douglas??? It's insulting to us if you are.... Your FP would send you to an endocrinologist with a low glucose like that and would not be stupid enough to tell you to eat more. You obviously are getting too much insulin and have a BIG problem. You are seeing a quack and need to find a better doctor. http://labtestsonline.org/understanding/analytes/c_peptide/test.html A C-peptide test is probably not something that is done STAT. I'm not sure if it's a test that's even done in most chemistry labs - may be a send-out to a reference lab. I haven't worked in there in 20 years; doesn't sound like a test that's ordered very often, though, from my foggy chemistry memory bank. From the URL above: "C-peptide measurements also can be used in conjunction with insulin and glucose levels to help diagnose the cause of documented hypoglycemia and to monitor its treatment. Symptoms of hypoglycemia may be caused by excessive supplementation of insulin, alcohol consumption, inherited liver enzyme deficiencies, liver or kidney disease, or insulinomas (tumors of the islet cells in the pancreas that can produce uncontrolled amounts of insulin and C-peptide)... C-peptide levels may be done when there is documented acute or recurring hypoglycemia. Symptoms include sweating, palpitations, hunger, confusion, blurred vision, fainting, seizures, and even loss of consiousness, although these symptoms also can occur with other conditions. The C-peptide test may be used to help separate excessive insulin production from excessive administration and to help diagnose insulinomas." Judy Dilworth, M.T. (ASCP) Microbiology > I'm a non-diabetic w/ a fasting blood glucose of 37 mg/dL, and > tremors, ataxia --which could be neurological as well--, restlessness, [quoted text clipped - 3 lines] > > Thanks!!! > Are you making up stuff again Douglas??? It's insulting to us if you > are.... Agree entirely. When he originally posted "I'm a non-diabetic w/ a fasting blood glucose of 37 mg/dL, and tremors, ataxia --which could be neurological as well--, restlessness, and occasional dizziness", he's actually contradicting an earlier post he maded in which he said he was sixteen years old and trying to be cute. I think he's trying to put a case history in the first person. He's pretending he's the doc with these abnormal results and he has a patient with these symptoms. Douglas, this is NOT a cute way to do this. If you want to make up a hypothetical patient and/or case history, please state that it IS a hypothetical patient and/or case history. Try to pick figures and lab results that are clinically possible. We really are NOT as dumb as you think. Again, with a blood sugar this low you would probably NOT be sitting around your living room casually calling your doc's office to make an appointment. You'd be passed out and/or in the ER. Judy Dilworth, M.T. (ASCP) Microbiology > Agree entirely. When he originally posted "I'm a non-diabetic w/ a > fasting blood glucose of 37 mg/dL, and tremors, ataxia --which could > be neurological as well--, restlessness, and occasional dizziness", > he's actually contradicting an earlier post he maded in which he said > he was sixteen years old and trying to be cute. On Sep 21, 12:20 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > I think he's trying to put a case history in the first person. He's > pretending he's the doc with these abnormal results and he has a patient [quoted text clipped - 20 lines] > > - Show quoted text - I'm serious about this one. My lab results have been repeated twice. Then you need to see an endocrinologist pronto. This is NOT normal. Hypoglycemia can be a precursor to diabetes. Judy Dilworth, M.T. (ASCP) Microbiology I'm serious about this one. My lab results have been repeated twice. > Then you need to see an endocrinologist pronto. This is NOT normal. > Hypoglycemia can be a precursor to diabetes. [quoted text clipped - 3 lines] > > I'm serious about this one. My lab results have been repeated twice. It's another of his games - look at his original post. He's trying to catch us out with the units. He was hoping we wouldn't know the difference between mg/dL and mmol/l. http://en.wikipedia.org/wiki/The_Boy_Who_Cried_Wolf I'm pretty sure we use mg/dl in the US, not mmol/l. That is a low reading according to my faint memory of chemistry normals here in Amerika. Douglas, what's your game here? Judy Dilworth, M.T. (ASCP) Microbiology > It's another of his games - look at his original post. > > He's trying to catch us out with the units. He was hoping we wouldn't > know the difference between mg/dL and mmol/l. > > http://en.wikipedia.org/wiki/The_Boy_Who_Cried_Wolf > I'm pretty sure we use mg/dl in the US, not mmol/l. That is a low reading > according to my faint memory of chemistry normals here in Amerika. For me the "35" bit is through the roof. until I saw the units > Douglas, what's your game here? Silly beggers, I would guess. > Judy Dilworth, M.T. (ASCP) > Microbiology [quoted text clipped - 5 lines] >> >> http://en.wikipedia.org/wiki/The_Boy_Who_Cried_Wolf > > I'm pretty sure we use mg/dl in the US, not mmol/l. That is a low reading > > according to my faint memory of chemistry normals here in Amerika. [quoted text clipped - 16 lines] > > - Show quoted text - I put the results in the units my lab report gave: 37 mg/dL, which is about 2.06 mmol/L. The la repeated it twice, and I'm having the FBG redrawn, along w/ a C-peptide , on Friday morning. What other tests do you believe should be ordered, proinsulin, ketones, cortisol, etc.? I put the results in the units my lab report gave: 37 mg/dL, which is about 2.06 mmol/L. The la repeated it twice, and I'm having the FBG redrawn, along w/ a C-peptide , on Friday morning. What other tests do you believe should be ordered, proinsulin, ketones, cortisol, etc.? ____________________________________________________________ What condition(s) are you suspecting? That might give you a clue as to what tests could be requested to be of diagnostic value. There is a lot of difference between a path lab and a Star Trek tricorder. http://en.wikipedia.org/wiki/The_Boy_Who_Cried_Wolf > I put the results in the units my lab report gave: 37 mg/dL, which is > about 2.06 mmol/L. The la repeated it twice, and I'm having the FBG [quoted text clipped - 8 lines] > > http://en.wikipedia.org/wiki/The_Boy_Who_Cried_Wolf Hyperinsulinemia, hormone deficencies, dietary deficencies, and insulinoma. Is a diagnostic fast necessary? > > "douglas" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 19 lines] > > - Show quoted text - Proinsulin levels are used to confirm an islet cell tumor as the cause of hyperinsulinemia. Patients have a higher percentage of proinsulin and even higher still in cases involving islet cell carcinoma. The percentage of proinsulin may be elevated in hypokalemic patients. Hyperinsulinemia by itself are generally obese individuals but tend to have a normal glucose level. About 2-4% of insulinomas may be associated with multiple endocrine adenomas I. There are a variety of tests for that including hormone testing for hyperfunction of the pituitary. First things first. If your previous glucose was a fasting, then, to compare apples to apples I would say yes, as glucose levels fluctuate with food intake. It's also best if you use the same laboratory for your repeat testing, if possible, as instruments vary in small ways. If your fasting is running this low, however, you probably should get someone else to drive you to the lab. However, this is something you need to check with the physician who ordered the blood work - not people on the internet. I do hope you see an endocrinologist. As I recall you are pretty young. A coworker has somewhat the same problems with her blood sugar. She sees an endocrinologist regularly and it has helped her immensely. They have put her on medication to stop the low glucose swings. When she was pregnant she developed gestational diabetes and was self-testing her glucose levels 3-4 times a day. Obviously this won't happen to you, but her concern was that she would stay diabetic post partum. She is in her mid-30's now, and has had this condition since her early 20's. She is not diabetic, but still has glucose problems and is still on medications. I must say, Douglas, that if this is legitimate then I wish you well. Your previous mischief has set people on this list on guard. Please learn from this and don't play us for fools any more. Judy Dilworth, M.T. (ASCP) Microbiology "douglas" <Protoman2050@gmail.com> wrote in message news:df8896ca-b232-4bd7-a2ec- Is a diagnostic fast necessary? On Sep 24, 9:49 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > If your previous glucose was a fasting, then, to compare apples to > apples I would say yes, as glucose levels fluctuate with food intake. [quoted text clipped - 28 lines] > news:df8896ca-b232-4bd7-a2ec- > Is a diagnostic fast necessary? I did check w/ Dr Phan -- my FP--, my friend Dr Asbill --an internist--, as well as my Mom --a RN--; they said to get them redrawn, and that they are very low. I'm going in on Friday morning for the labwork and a discussion. Wish me luck! For future reference, in any hypothetical situations I post about, I'll clearly indicate they are hypothetical. On Sep 24, 9:49 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > If your previous glucose was a fasting, then, to compare apples to > apples I would say yes, as glucose levels fluctuate with food intake. [quoted text clipped - 28 lines] > news:df8896ca-b232-4bd7-a2ec- > Is a diagnostic fast necessary? Could my body be in ketosis, using fatty acids for energy? Maybe that's why I'm not passed out. On Sep 22, 10:33 am, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Then you need to see an endocrinologist pronto. This is NOT normal. > Hypoglycemia can be a precursor to diabetes. [quoted text clipped - 3 lines] > > I'm serious about this one. My lab results have been repeated twice. I've asked Dr Phan to consult the internist in his group, Dr Asbill. Do you think a C-peptide and ketones need to be ordered? > On Sep 22, 10:33 am, "JEDilworth" <bactit...@nospamhortonsbay.com> > wrote: [quoted text clipped - 13 lines] > I've asked Dr Phan to consult the internist in his group, Dr Asbill. > Do you think a C-peptide and ketones need to be ordered? Are you sure it isn't Dr Billass? Read Judy's post above is it is pretty much complete and self explanatory. C-peptide is used to determine exogenous injection of insulin where it would be undetectable. It takes 3-6 weeks to form insulin antibodies in response to exogenously administered insulin and so that is another test one can do for fictitious hypoglycemia, Rare cases of insulin autoimmune syndrome with hyperinsulinemia has been reported. Are you injecting yourself with insulin? Glucose and simultaneous insulin levels are needed in such cases in search of inappropriate high insulin levels in relation to the glucose level. An endocrinologist is needed to rule out an insulinoma. A fasting glucose under 40 with symptoms would warrant that. There can be other artifactual reasons such as delay in testing of glucose levels not separated from the red cells in warm weather which might cause lower glucose levels than expected. The mechanism of ketogenesis is still not completely understood. "Two steps are required for ketogenesis: (1) enhanced lipolysis with an increased delivery of free fatty acids to the liver and (2) an alteration in hepatic metabolism by which these free fatty acids are converted preferentially into ketones instead of into triglycerides. Decreased insulin activity, increased counter-regulatory hormone levels (primarily glucagon, but also cortisol, catecholamines, and growth hormone), and volume depletion all play a role in ketogenesis." Type I diabetes and low levels of insulin can stimulate ketogenesis as can alcoholic ketoacidosis which the above describes. The ketone excess is to the point of acidosis when compared to simple fasting. There is no clinical reason to do BHB testing. > > On Sep 22, 10:33 am, "JEDilworth" <bactit...@nospamhortonsbay.com> > > wrote: [quoted text clipped - 48 lines] > > - Show quoted text - There is no way I can get extraneous insulin, since no-one I know is diabetic. And why on earth would I do that? The lab repeated their runs twice, b/c they suspected that, according to the report. Same values both times. I do not drink alcohol. Douglas wrote: >There is no way I can get extraneous insulin, since no-one I know is diabetic. And why on earth would I do that? Well, hypoglycaemia could be seen in a starving patient - and injecing insulin has been attempted as a way to weight loss. But I don't know you from anything else than your postings here - and since I cannot judge your mental condition I can only say that it does happen that some patients who show an almost nerdy interest in medicine do inflict strange symptoms in order to appear sick and get the interest of specialists - whre they can then get into a dialogue on their favorite interest. >The lab repeated their runs twice, b/c they suspected that, according to the report. Same values both times. If an odd result comes up and retesting is easy and relatively costless, they would. Then at least they are sure the result is valid for the particular blood tested. Which pre-analytical errors might influence it, is hard to say - However the measured blood glucose is very low and would - should - ring a bell or two. >I do not drink alcohol. So much more for the rest of us - have to get that liver up and running > Douglas wrote: > >There is no way I can get extraneous insulin, since no-one I know is [quoted text clipped - 24 lines] > > So much more for the rest of us - have to get that liver up and running I'm interested in medicine, but not so much as to make me sick just for that purpose. > Douglas wrote: > >There is no way I can get extraneous insulin, since no-one I know is [quoted text clipped - 24 lines] > > So much more for the rest of us - have to get that liver up and running Pre-analytical or specimen integrity issues can result in low glucose values if the specimen is left in contact with red blood cells for long periods of time before testing is done. A special tube containing preservative anti-glycolytic chemicals are needed for long delays in glucose testing or separation of serum from red cells. Heat also makes the glycolysis in a blood sample worse and will drop the glucose blood values. Retesting only tests the same sample and eliminates precision error although accuracy can not be validated by such testing. > > Douglas wrote: > > >There is no way I can get extraneous insulin, since no-one I know is [quoted text clipped - 36 lines] > > - Show quoted text - The lab thought that, too, apparently, b/c it was on my lab report. They retested it, and got the same answer. > > > Douglas wrote: > > > >There is no way I can get extraneous insulin, since no-one I know is [quoted text clipped - 41 lines] > > - Show quoted text - One does not check specimen integrity by retesting it. One checks it by re-submitting another sample. You can test the same sample a hundred times but that does not mean there is nothing wrong with the sample being tested.. It does not prove that something isn't wrong with the specimen. That is only valid only for the detection of analytical errors and not specimen integrity. If you don't get the same result on repeat than there is a prescision error with the instrument. If you get the same result that in and of itself does not mean the instrument isn't giving low results on every specimen out there. There has to be other ways to confirm accuracy. Such a low result is a critical value result and would be called to the caretarker for immediate action. Some institutions have a repeat policy before reporting out such critical values. We do not based on documented studies. We do have a comment based on the condition of the specimen submitted that may yield altered results. Such a specimen would be a red top tube uncentrigued and left out at high temperatures for hours. The decrease in glucose has been calculated in the literature and can be significant. The recommendation is centrifuation immediately after collection in gel separation tubes. This minimizes the reduction although it doesn't eliminate it. The preferred submission of a sample for glucose testing is a gray-top tube containing glycolytic inhibitors. Specimen integrity such as delayed testing in an improperly preserved sample may also give elevations of potassium as a result of cell leakage vs insulin adminstration that results in low potassium levels. The rest of the chemistry panel is also helpful for checking specimen integrity and other endocrine abnormalities such as Addisons. One looks at the total lab findings along with the clinical picture to put it all together. Robert makes an excellent point about glucose testing. If glucose specimens are going to be transported and not spun down, a sodium fluoride (gray top) tube is essential. Otherwise, you will get the problems he's talking about. The blood should be separated by centrifugation and tested as soon as possible. Glucose is only stable for a couple of hours in tubes other than a gray top. The serum/plasma should NOT sit on the cells. This is basic good lab practice for any blood work that requires centrifuged specimens. These are basics that are taught to all medical technology students in their training. I personally would recommend your going to an in-house draw station at a hospital. The specimen will be transported to the laboratory pretty quickly, whereas an offsite draw station depends on couriers for transportation. Depending on the facilities at the draw station they may or may not have a centrifuge to separate your specimen before transportation. If you're having your blood drawn at a doc's office, you are entirely dependent on their staff to know what they're doing with laboratory specimens. If it's a very large clinic with their own in-house lab, that's one thing and a good thing. If this is just a doc's office in a building and the secretary/nurse/lab assistant is taking care of your specimen, i.e. just popping the tubes into a bag and sending them off to the lab by way of putting them in the drop box on the office door, that COULD be your problem. Most reference labs supply their clients with small centrifuges but that doesn't necessarily mean that the doc's offices know how to use them. Hopefully your glucose testing wasn't performed in a doctor's office. That's even scarier if that was the case. I marketed laboratory services to doctor's offices for two years in the mid-80's. I know whereof I speak. We ran into all types of analytical errors from doctor's offices who didn't know the first thing about collecting laboratory specimens. The specimen provided to the lab for analysis is everything. The lab has no control over pre-analytical errors in collection. We dealt with offices putting blood specimens into lock boxes when the outdoor temperatures were near zero. What do you think happens to blood at that temperature? It freezes and lyses the cells. Testing requiring whole blood (CBC's [complete blood counts]) are pretty worthless when frozen. Many times the courier doesn't pick up until hours after the docs offices close and put the specimens in the drop box. One of our clinics was performing in-house chemistry testing but they hadn't run controls in months and months. They didn't do any routine maintenance on their equipment either. I was brought in as a consult. I was horrified. They were actually charging MONEY for this testing. It was pitiful. I worked for a small draw station before I was a marketing rep. I did very limited testing onsite and the rest was sent up to the main laboratory. We were extremely careful with our pre-analytical processing but it still had to travel distances. We kept specimens refrigerated until our courier took them in a Styrofoam package in his cooler, but it took about 4 hours to get to the lab by car. Specimens travel all over the country every day via courier. That is why it is important to adhere strictly to lab collection requirements. We also got lab work from the docs in the building. We had a pediatrician across the hall who had a young teen patient that they suspected of being pregnant. They had their own urine pregnancy kit but the results came up negative. They brought the urine over to me and I ran it. The result was definitely positive. I went over to the office and checked their kit. The date was right but they stored it at room temperature. The kit was definitely supposed to be in the refrigerator. I also do not think they ran controls so they didn't know that the kit was not working. As a marketing rep I ran into quite a few similar horror stories from doctor's offices. If you repeatedly test an incorrectly collected specimen, the results will match within a couple of numbers time and time again, so repeating specimens doesn't mean much. A glucose in your range might repeat at 37, 39, 38, 36 and still be statistically correlated, as 1 mg/dl doesn't mean much clinically. Take your blood requisition and go to a large hospital that is on your insurance plan, if you haven't already done so. Make sure to ask your doc whether you should be fasting or not. A correct fast for glucose should be eight hours with nothing by mouth except water. No gum, no coffee, no diet pop, just water. If lipid testing is ordered then your fast should be 12-14 hours with nothing except water by mouth. They will transport to the laboratory every half hour or so, and chemistry specimens like glucoses are loaded onto the analyzers quickly, so there shouldn't be pre-analytical errors. Docs are notorious in not telling their patients to fast when they really WANT them to be fasting, so be sure and check. Good luck and let us know how things come out. Thanks for your "hypothetical" promise. We on the group appreciate it. Judy Dilworth, M.T. (ASCP) Microbiology On Sep 25, 4:21 pm, douglas <Protoman2...@gmail.com> wrote: > On Sep 25, 3:49 pm, Robert <Goldentouch...@yahoo.com> wrote: One does not check specimen integrity by retesting it. One checks it by re-submitting another sample. On Sep 25, 7:49 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Robert makes an excellent point about glucose testing. If glucose > specimens are going to be transported and not spun down, a sodium [quoted text clipped - 92 lines] > One does not check specimen integrity by retesting it. One checks it > by re-submitting another sample. Another case presented to us was a patient on high dose vitamin C that falsely lowered glucose values by glucose oxidase methods. It was giving 50 something on such methods and when glucose was given there was no response. A 250 mg/dl was obtained by a non-glucose oxidase method. Some methodologies incorporate an ascorbic oxidase additive to rid the interference but not all. The normal procedure if at all possible is to perform the questionable assay with an alternative methodology. This applies to all chemistry testing. In general terms once one looks into specimen integrity and lab results are unexpected then drug interference is the first thing one thinks of. The repeat sample can also take care of pre-, analytical, post- analytical phases errors. On Sep 25, 7:49 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Robert makes an excellent point about glucose testing. If glucose > specimens are going to be transported and not spun down, a sodium [quoted text clipped - 92 lines] > One does not check specimen integrity by retesting it. One checks it > by re-submitting another sample. Actually, the lab report says that RBCs were present when they recieved it. , but then it says "verified by repeat analysis". What does this mean? The lab was Quest Diagnostics > On Sep 25, 7:49 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> > wrote: [quoted text clipped - 106 lines] > > - Show quoted text - RBC's should not be present without an inhibitor especially since Quest is a reference lab and there were delays in testing. The RBC's utilize the glucose for energy as they lack mitochondria. If the results and comment were together then it pertains to the glucose result as a qualifier pertaining to the integrity of the specimen. There should be safeguards to ensure the integrity of the specimen as Judy stated if it can't be done immediately a doctors glucometer testing in the office might be warranted along with proper collection and processing of the specimen for glucose testing. The doctor was probably informed of the problem when he was notified of the result. There should have been a documentation of such a call as it was a critical value. It might also explain the doctors response to such a result. informed of the problem when he was notified of the result. snip > There should have been a documentation of such a call as it was a > critical value. It might also explain the doctors response to such a > result Absolutley Am I missing something ? A 2.1 FBS in an otherwise healthy non diabetic is a "critical" result and would be repeated and phoned. The lab can only assure the steps they have control over. There are several scenarios previously discussed for false low readings, but presumably the responsible physician interprets the results in light of the clinical picture. > informed of the problem when he was notified of the result. > snip [quoted text clipped - 10 lines] > presumably the responsible physician interprets the results in light > of the clinical picture. Right you are and quite frankly I don't think the doctor believed it to be that low but was again informed of the condition of the specimen by the lab as a warning that the results might have been affected by the condition of the specimen received. In this case they commented the presence of RBC contact is my interpretation of the comments. A simple redraw with a preservation of the specimen is the next action that should be taken and then go from there. Had the circumstances been different with testing done on a stat basis and quickly then the results would have been more significant. It seems the doctor just gave a precautionary warning to eat just in case there really is hypoglycemia. The degree of hypoglycemia does in fact have an impact on the differential diagnosis in relation to the clinical picture as you state. Quest is a reference lab - biggest in the country. http://www.questdiagnostics.com/ The regional lab I used to sell for was eventually absorbed by Quest in the early 90's. They have hub labs all over the U.S. However, that doesn't mean that preanalytical errors were not present. I have never seen the comment "RBC's present" on a glucose report, although it probably indicates that the serum/plasma was hemolyzed. This condition, in which the red cells leak their contents into the serum or plasma, can affect many results - most specifically glucose and potassium. This could be because they had a hard time drawing blood from you or the phlebotomist in charge of the draw station let the blood sit too long before it was spun down. It could have sat in a hot car while being transported to the lab. There are any number of reasons this could have happened. Quest techs were obligated to call this result as it is indeed a critical glucose. However, the technologist helped to explain the result by putting in the "RBC's present" comment. All reference labs have to deal with the specimen that they're dealt. I would definitely opt for a local hospital's lab (if your insurance will support that choice) over shipping your specimen to one of the big Quest labs. The courier probably only picks up once a day from their draw station and there was definitely a delay in testing. Glucose is always more accurate when it is tested quickly. They can fax the result over to your doc within hours. Let us know what happens. Judy Dilworth, M.T. (ASCP) Microbiology Actually, the lab report says that RBCs were present when they recieved it. , but then it says "verified by repeat analysis". What does this mean? The lab was Quest Diagnostics On Sep 25, 10:15 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Quest is a reference lab - biggest in the country. > [quoted text clipped - 34 lines] > > The lab was Quest Diagnostics I'll inform Dr Phan, then. > The lab was Quest Diagnostics I'll inform Dr Phan, then. ____________________________________ As a matter of courtesy, it's probably best not to broadcast specific individual's names over the Internet. > > The lab was Quest Diagnostics > [quoted text clipped - 4 lines] > As a matter of courtesy, it's probably best not to broadcast specific > individual's names over the Internet. There's around several million people w/ the name "Phan". > > "douglas" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 10 lines] > > There's around several million people w/ the name "Phan". OK, the FBG was redrawn in a tiger-striped-stoppered tube. My PCP should be calling me this evening to discuss a letter I left in his office about the investigation and management of my as-of-yet- idiopathic hypoglycemia. Btw, I have been mildly euphoric for the past couple of days; is this related? > > > "douglas" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 20 lines] > > - Show quoted text - If you have a doctor who takes blood for glucose into any tube not grey - topped and a lab that measures glucose in a tube without preservative you need to find a new doctor and a new lab. > > > > "douglas" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 26 lines] > > - Show quoted text - I told the MA who did it that. It was a SST tube she used; there was a grey tube right next to it. WHO drew your blood? The doctor's office? Like Mike said - if this was drawn in any tube besides a gray top (for the glucose - the SST red top with the stripes can be used for other testing if he ordered it) you could run into the same problem again unless you went right to a hospital on-site draw station where they process the blood quickly. SST tubes are serum separator tubes, have no anti-coagulant and no preservative. The goo in the tubes separates the cells from the serum once it is centrifuged. HOWEVER, if it is centrifuged twice (which could have happened the first time - or the second) for any reason (they didn't let it clot long enough the first time for some reason, and thought they could get more serum with a second spin) then the cells below CAN mess up the serum. Again, this is something that real lab people wouldn't (shouldn't) do but the bets are off with doc's office personnel. Gray tubes have sodium fluoride, I believe, as an anticoagulant AND a preservative for blood glucose and a couple of other tests that I can't remember off the top of my head (too many years out of chemistry). It inhibits glycolysis and helps prevent too LOW of a glucose reading. http://medical-dictionary.thefreedictionary.com/gray+top+tube It is best that you do not put your doc's names in these postings. He would not appreciate it, especially if he has other patients who read this. It is not difficult to figure people out with the internet available. Euphoria implies a state of happiness. Are you sure that's the word you want to use here? http://dictionary.reference.com/browse/euphoria - a feeling of happiness, confidence, or well-being sometimes exaggerated in pathological states as mania. Are you manic??? :-| Judy Dilworth, M.T. (ASCP) Microbiology OK, the FBG was redrawn in a tiger-striped-stoppered tube. My PCP should be calling me this evening to discuss a letter I left in his office about the investigation and management of my as-of-yet- idiopathic hypoglycemia. Btw, I have been mildly euphoric for the past couple of days; is this related? On Sep 26, 4:25 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > WHO drew your blood? The doctor's office? Like Mike said - if this was > drawn in any tube besides a gray top (for the glucose - the SST red top [quoted text clipped - 41 lines] > Btw, I have been mildly euphoric for the past couple of days; is this > related? It was a medical assistant...scary, I know. I meant floaty and in an upbeat mood. I'm not a maniac On Sep 26, 4:25 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Are you manic??? :-| > [quoted text clipped - 10 lines] > Btw, I have been mildly euphoric for the past couple of days; is this > related? It was a medical assistant...scary, I know. I meant floaty and in an upbeat mood. I'm not a maniac _____________________________________________________ Manic, not maniac. > On Sep 26, 4:25 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> > wrote: [quoted text clipped - 20 lines] > > Manic, not maniac. Not that either. Yes, Douglas, I know that your blood was drawn by an assistant or phlebotomist. That is almost always the case. What I want to know is.... Did you leave the doc's office and go to a draw site for a big lab (no need to name names), stay in your doc's office and have one of their people draw you, or go out to a hospital lab's draw site for the blood draw? As you MAY recall, we've been discussing at length the transport time of your specimen to the lab and how it may or may not have affected your lab results. This seemingly is the critical part of the puzzle and may help to explain why your glucose level was low the first time. Please answer the question. You're probably euphoric because you're getting a LOT of attention here lately. FYI, "manic" is an adjective; "maniac" is a noun. Judy Dilworth, M.T. (ASCP) Microbiology It was a medical assistant...scary, I know. I meant floaty and in an upbeat mood. I'm not a maniac On Sep 27, 7:13 am, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Yes, Douglas, I know that your blood was drawn by an assistant or > phlebotomist. That is almost always the case. What I want to know is.... [quoted text clipped - 19 lines] > > I meant floaty and in an upbeat mood. I'm not a maniac Stay in the doc's office. I'm going to ask him to send me to the lab, which is RIGHT next to the office building, next time. Btw, I was weirdly euphoric BEFORE I posted here. If it's low again, then they are probably NOT spinning the blood down in a timely manner. If they did NOT use a gray top tube that's even worse. I would demand to get my blood drawn at a draw station at a hospital - NOT the lab next door. They are going to have the same transit time issues. Hopefully you don't live way out somewhere far away from a hospital. If the insurance company refuses to pay for all of these repeats, I would challenge it based on the fact that your doc's office probably doesn't process blood correctly. They may be batching their blood till the end of the day and taking the specimens over to the lab next door themselves! I would make sure there are no pre-analytical collection errors before you go to an endocrinologist. If you feel intimidated by the doctor, ask your mother to step in. Judy Dilworth, M.T. (ASCP) Microbiology Stay in the doc's office. I'm going to ask him to send me to the lab, which is RIGHT next to the office building, next time. On Sep 27, 9:31 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > If it's low again, then they are probably NOT spinning the blood down in > a timely manner. If they did NOT use a gray top tube that's even worse. [quoted text clipped - 16 lines] > Stay in the doc's office. I'm going to ask him to send me to the lab, > which is RIGHT next to the office building, next time. I WILL, next time when I go in for my wart removal!!!! The lab next door is unaffiliated. Make sure you check your insurance provider's list to see which ones will actually pay for your lab work. In the U.S., at least, this is important. Again, if "the lab next door" is sitting miles from the "mother hospital" or the main lab, you have transit issues. If you were truly hypoglycemic you'd be having a lot of symptoms. My coworker had lots of problems with hunger that was never satisfied. She couldn't gain weight. She would get light headed and nearly pass out. This started in her early 20's. If you're a teenager, you can't gauge your symptoms on hunger issues, as most teenage boys are hungry constantly. Only reason I invoked your mom/dad in the previous post was that they are the ones that will ultimately have to deal with insurance claims and issues. Judy Dilworth, M.T. (ASCP) Microbiology I WILL, next time when I go in for my wart removal!!!! The lab next door is unaffiliated. On Sep 28, 10:32 am, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Make sure you check your insurance provider's list to see which ones > will actually pay for your lab work. In the U.S., at least, this is [quoted text clipped - 19 lines] > > The lab next door is unaffiliated. Then again, I haven't been really hungry in the last few days...today I just drank a Venti Frappachino; could I be in ketosis? Is a low FBG the cause or sign of ketosis? You can buy ketone strips at a drug store and dip your own urine if you're worried about this. Follow the timing and compare the strip to the colors on the container. Watch storage conditions and expiration date. Don't store these in a humid bathroom - they will deteriorate quickly that way. What in the h**l is a Venti Frappachino? Are you name dropping? Sounds expensive with absolutely no nutritive value whatsoever. Judy Dilworth, M.T. (ASCP) Microbiology Then again, I haven't been really hungry in the last few days...today I just drank a Venti Frappachino; could I be in ketosis? Is a low FBG the cause or sign of ketosis? Douglas, Ask the office personnel who their accreditation agency. If they are doing in house testing then they have to have one. What tests are they doing "in-house" as opposed to sending to a reference lab. If they are only drawing/collecting specimens then they may not be accredited. Just ask them. I would have no way of knowing who their accreditation agency would be. Marsha Mank, MT(ASCP) Technical Advisor COLA > You can buy ketone strips at a drug store and dip your own urine if you're > worried about this. Follow the timing and compare the strip to the colors [quoted text clipped - 10 lines] > I just drank a Venti Frappachino; could I be in ketosis? Is a low FBG > the cause or sign of ketosis? Marsha makes an excellent point. IF they are doing lab work in the office then they need to be accredited for what they do. They have check samples they must perform periodically. She knows whereof she speaks, as COLA is a lab accreditation agency: http://www.cola.org/ If they are just drawing and sending to a reference lab they are probably doing it for the drawing fees and/or a discount on account billing that their lab marketing rep is giving them for non-Medicare work. You cannot discount Medicare work. Then the doc can do the billing and pocket the difference. This is still allowed in some states. If you get a bill directly from the reference lab, then they are doing "patient" billing and they're only making out on the draw fee. Countries that have government-run medicine have no idea how complicated billing is in the US - and how many loopholes there are in it (but that's a different topic....). If they are just drawing, they are still responsible for pre-analytical processing - hence with the potential problem of the serum/plasma sitting on the cells too long. Non-lab people do not realize the potential of screwing up lab work by doing this. Many of them spin specimens in SST tubes twice also, which also can mess up tests like glucose and potassium. Go to a lab where transit time from being drawn to getting testing done is SHORT. Hospital-based lab draw stations are about as fast as you can get as an outpatient. Judy Dilworth, M.T. (ASCP) Microbiology > Ask the office personnel who their accreditation agency. If they are > doing in house testing then they have to have one. What tests are they [quoted text clipped - 5 lines] > Marsha Mank, MT(ASCP) > Technical Advisor COLA On Sep 29, 3:38 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Marsha makes an excellent point. IF they are doing lab work in the > office then they need to be accredited for what they do. They have check [quoted text clipped - 39 lines] > > - Show quoted text - I quote from the phlebotomist "we spin it immediately, then send it to Quest"; an internist I know says it's okay, but not preferred, to use an SST IF the serum is immediately seperated from the RBCs. Technically that is true. However, they need to let the SST clot before spinning it. That usually takes about 20 minutes. IF they tried spinning before clotting was completed, they may not have gotten a good serum yield. That leads me to my speculation that they they plunked the tube BACK in the centrifuge and tried spinning a second time, which causes all sorts of problems with SST tubes. Blood can leak up from below the gel barrier and mess up the serum. A gray top tube is better but involves drawing more blood from the patient. However, from a young person like you that shouldn't be a problem. BTW, I was thinking more about your sugary coffee drink. When someone who MAY be hypoglycemic (we don't know in your case) eats (or drinks) a lot of sugar, their insulin level will go up abnormally, which will then depress the blood glucose level. In the old days they used to run glucose tolerance testing and you could see hypoglycemics running into trouble around the 4th-6th hour of testing. GTT's involve drinking a test beverage containing 100 gm of glucose. They don't run these too often any more. Hypoglycemics' glucose levels can plunge below 50 mg/dl (I think that's the unit) and definitely cause symptoms. IF you are truly hypoglycemic, you need to stay away from high levels of glucose and eat more protein. My coworker sticks to protein snacks and tries to stay away from sugary stuff. This keeps her glucose levels more stable. Let us know what your repeat blood sugar is. Judy Dilworth, M.T. (ASCP) Microbiology "douglas" <Protoman2050@gmail.com> wrote in message news:05232413-2be6-44f7-bd0d-> I quote from the phlebotomist "we spin it immediately, then send it to Quest"; an internist I know says it's okay, but not preferred, to use an SST IF the serum is immediately seperated from the RBCs. On Sep 29, 10:55 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Technically that is true. However, they need to let the SST clot before > spinning it. That usually takes about 20 minutes. IF they tried spinning [quoted text clipped - 5 lines] > involves drawing more blood from the patient. However, from a young > person like you that shouldn't be a problem. snip Everyone seems egar to find fault with SST tubes. They are perfectly fine for measuring most routine analytes, glucose included, when used appropriately, and when specimen transport and analysis is going to be delayed, as is the nature of out patient blood work, they are the tube of choice as they separate the serum/plasma from the red cells and help maintain specimen integrity without the need for human handling of open tubes, labelling aliquots etc, and the errors such handling and transcripion are prone to produce. We do use gray tops in house for GTT's but I think they only make a real difference if there's going to be a delay in processing. I can understand that such a low glucose in an asymtomatic patient makes everyome suspect lab error, but I seem to recall acute symptoms in the OP. It would be interesting to see F.U. blood work and any input from an endocrinologist if these results are validated > I quote from the phlebotomist "we spin it immediately, then send it to > Quest"; an internist I know says it's okay, but not preferred, to use > an SST IF the serum is immediately seperated from the RBCs. I agree, Rick, with your comments about SST's. They are a wonderful invention that saves LOTS of work. I can remember when I first started in the lab in late 1971 we used plain red tops with no gel, as SST's had not been invented yet. We spun, poured off, and respun just the pour-off serum tubes a second time to get rid of all the red cells (with no caps on the tubes [shudder]) and poured off AGAIN. All tubes were hand-labeled with name and room number (no bar code labels in those days). The morning draw was a pretty labor intensive time. However, Douglas's low blood sugar was resulted with some caveat that RBC's were present. Not sure exactly what this means other than that the specimen might have been hemolyzed or there were red cells floating in the serum. I think you will agree that a 37 mg/dl fasting is NOT normal. Before expensive endocrinologists are summoned pre-analytic error MUST be ruled out and a true low fasting blood sugar must be duplicated. Otherwise, this could be much ado about nothing. I am only going from my experience as a marketing rep and the problems I dealt with in doctor's offices with non-lab personnel dealing with specimens. Hopefully all specimens were handled appropriately. However, I still think that, to rule out transport related low glucose levels, a blood draw should occur close to where the testing will actually be done. You said yourself that gray tops should be used if there is a "delay in processing." We don't know how far away this doctor's office is from the reference laboratory. If he is drawn in the morning and the blood isn't tested until after 10:30 p.m. (a typical time for reference labs to START receiving their specimens from afar) that is a good 12-14 hour delay right there! Our local specimens did not reach our "main lab" until about that time, and our driver left our city at around 5 p.m. with our daily draw. We spun down the specimens (in SST's AND gray tops) and kept the specimens in a refrigerator until the driver left, but I would tend to doubt that ALL doc's offices do that. A hospital lab would have had the specimens done and reported out by then. Judy Dilworth, M.T. (ASCP) Microbiology "rickh" <harrison6723@rogers.com> wrote in message news:50236327-12b5-4c00-81cf- Everyone seems eager to find fault with SST tubes. They are perfectly fine for measuring most routine analytes, glucose included, when used appropriately, and when specimen transport and analysis is going to be delayed, as is the nature of out patient blood work, they are the tube of choice as they separate the serum/plasma from the red cells and help maintain specimen integrity without the need for human handling of open tubes, labelling aliquots etc, and the errors such handling and transcripion are prone to produce. We do use gray tops in house for GTT's but I think they only make a real difference if there's going to be a delay in processing. I can understand that such a low glucose in an asymtomatic patient makes everyome suspect lab error, but I seem to recall acute symptoms in the OP. It would be interesting to see F.U. blood work and any input from an endocrinologist if these results are validated > On Sep 29, 10:55 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> > wrote:> Technically that is true. However, they need to let the SST clot before [quoted text clipped - 29 lines] > > - Show quoted text - That is correct as they are the tube most widely used for general chemistry panels with the caveat that they be handled as recommended by the manufacturers of the SST tubes themselves. It is the responsibility of the performing laboratory to establish specimen integrity rejection criteria. From a recent MLO article pertaining to the performance of testing with unacceptable specimens, hemolysis or the storage mishandling as denoted by the laboratory with regards to " presence of blood" denoted in the report can make the laboratory legally responsible for such actions. There is no discharge of liability from the laboratory if the doctor, clinician, insists that an unacceptable specimen be tested. The laboratory intentionally performed a test they knew was unacceptable and is an admission of liability. If one reports out a K of 8 and attaches a comment that the specimen is hemolyzed this denotes an intentional willful act of reporting out a value that is inaccurate and incorrect. Any actions taken as a result of that report with ill consequences to the patient would expose the laboratory legally. The bottom line is the laboratory is legally bound by established policies and procedures on what is an acceptable specimen and must adhere to it. The only one who is legally mandated through laboratory legislation, inspections, state and federal and by licensing of professionals are the laboratory personnel to make those judgement calls. The reference laboratory that picks up those samples need to be proactive to ensure that those preanalystical variables affecting testing are acceptable. If the sample is received by the laboratory unspun and collected 8 hours previously then no one would know except for the laboratory who performed it. With regards to the possibility of hypoglycemia, When one is specifically looking for glucose then a gray-top tube would be in order. This wasn't the case with the initial chemistry panel and as you mentioned glucose tolerance testing routinely uses gray top tubes. We use gray top tubes with all single glucose testing from remote units such as clinic testing. It would be an error not to do so in this case after the possibility of handling errors again mentioned by the report. There is no safeguards that the same thing won't happen again. Most doctors offices have glucometers and I would have him come into the office and have one done along with evaluation of symptoms and if low less than 50 mg/dl then they would have a lab slip in hand for an expanded insulin glucose ratio and held for add on testing. That would have been the quickest and most efficient way of doing it. > On Sep 29, 10:55 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> > wrote:> Technically that is true. However, they need to let the SST clot before [quoted text clipped - 29 lines] > > - Show quoted text - I find fault with measuring glucose in SST tubes. It may be OK for tubes handled correctly but you don't know if they have been handled correctly. The problem comes mainly with low glucose results. You don't know whether they have been centrifuged at the right time. You can't believe the time written on the tubes - or sometimed even the date. For the trifling extra time and money you can be sure your results have not been compromised by incorrect handling. We put about 3.000 tubes per day on our track and each extra glucose tube ony adds 2 seconds to the processing time over adding glucose to an SST sample. > > On Sep 29, 10:55 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> > > wrote:> Technically that is true. However, they need to let the SST clot before [quoted text clipped - 42 lines] > > - Show quoted text - I have personal experience with my own glucose measurements. When I did it fresh draw fasting and performed immediately I would consistently get 102 or about there. When I have it done at a drawing station for send out testing I consistently get 80's for the glucose coming back and the drawing station has a centrifuge there and use SST's because I also get a lipid panel at the same time. Why that is or if it's a normal acceptable variant is a good question. Ideally one would do correlation studies with of having a test performed immediately versus the standard routine. It might not be clinically significant. Another option in this case is to perform a glycohemoglobin in which if hypoglycemia is predominant then a lower A1C value would be of value. A1C is used for both high or low glucose conditions. > > > On Sep 29, 10:55 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> > > > wrote:> Technically that is true. However, they need to let the SST clot before [quoted text clipped - 58 lines] > > - Show quoted text - In the first hour fluoride blood glucose declines at the same rate or slightly faster than untreated blood but the level then stabilises in the fluoride tube but continues to drop in the untreated tube. See: http://www.clinchem.org/cgi/reprint/35/2/315 Effectiveness of Sodium Fluoride as a Preservativeof Glucose in Blood A.Y.W. Chan, A. Swamlnathan,and C. S. Cockram CLIN. CHEM. 35/2, 315-317(1989) > Another option in this case is to perform a > glycohemoglobin in which if hypoglycemia is predominant then a lower > A1C value would be of value. A1C is used for both high or low glucose > conditions. This is an excellent point. Douglas has to realize that the practice of medicine can't diagnose a serious illness based on a single point lab test. The doc has to look at a variety of tests that may indicate a problem, or corroborate a finding. The patient's signs, symptoms and physical exam also play into it.  SignatureJohn Gentile MS, M(ASCP) Laboratory Information Mgr. VA Medical Center Providence, RI yjgent@cox.net Thanks, Mike, Robert, and John for all the great information on chemistry, glucose, etc. It's been awhile since I've thought about all of this stuff. Nice to know I haven't forgotten it all :-(. I had never thought about A1C testing for low glucose. Heck, that test didn't even EXIST when I trained in 1973-74. I also wonder why they didn't do a fingerstick blood sugar with a glucometer in the doc's office. That would be quick and easy (making the BIG assumption that they run QC for this instrument like they should be doing daily). Douglas, are you having ANY symptoms right now? Judy Dilworth, M.T. (ASCP) Microbiology On Sep 30, 8:32 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Thanks, Mike, Robert, and John for all the great information on > chemistry, glucose, etc. It's been awhile since I've thought about all [quoted text clipped - 10 lines] > Judy Dilworth, M.T. (ASCP) > Microbiology Not that I know of; although when I got my bp tested at school, it fell 10 mmHg when I stood up vs when I was sitting down. On Sep 28, 9:06 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > You can buy ketone strips at a drug store and dip your own urine if > you're worried about this. Follow the timing and compare the strip to [quoted text clipped - 11 lines] > I just drank a Venti Frappachino; could I be in ketosis? Is a low FBG > the cause or sign of ketosis? Um, a Starbucks cold coffee milkshake-like drink? I can't believe you've never heard of it. On Sep 28, 9:06 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > You can buy ketone strips at a drug store and dip your own urine if > you're worried about this. Follow the timing and compare the strip to [quoted text clipped - 15 lines] > I just drank a Venti Frappachino; could I be in ketosis? Is a low FBG > the cause or sign of ketosis? Um, a Starbucks cold coffee milkshake-like drink? I can't believe you've never heard of it. ________________________________________________________ I've never heard of it either. > On Sep 28, 9:06 pm, "JEDilworth" <bactit...@nospamhortonsbay.com> > wrote: [quoted text clipped - 26 lines] > > - Show quoted text - Where do you live?! http://en.wikipedia.org/wiki/Frappuccino I don't drink coffee - EVER (especially cold coffee). Ugh. We have a few in our town but I never go in them. My husband buys their ground coffee. I am in the upper Midwest (north Central). Manky is in the UK. I have no idea how far Starbucks has expanded. Some places don't have them on every corner. What does this have to do with blood glucose??? How much sugar is in one of those???? Judy Dilworth, M.T. (ASCP) Microbiology >I don't drink coffee - EVER (especially cold coffee). Ugh. We have a few in >our town but I never go in them. My husband buys their ground coffee. I am [quoted text clipped - 5 lines] > What does this have to do with blood glucose??? How much sugar is in one > of those???? I've actually had one of those things. It was rather disgusting, and not that sugary. > If you feel intimidated by the doctor, ask your mother to step in. That bit made me smile Quite possibly his mom may be intimidated by the doctor also. I admit that's the main reason I got out of marketing - the doc intimidation factor was something I couldn't overcome. Some of them have two faces: one for their patients and another for marketing reps. It can get pretty ugly.... Judy Dilworth, M.T. (ASCP) Microbiology That bit made me smile On Sep 28, 10:34 am, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Quite possibly his mom may be intimidated by the doctor also. I admit > that's the main reason I got out of marketing - the doc intimidation [quoted text clipped - 6 lines] > > That bit made me smile Actually, my doctor is extremely nice; he's young, too. Probably just got out of residency. I'll just print out that vacutainer-color-codes- and-what-they-mean sheet I found on the internet and give to him. Btw, are chemistries supposed to use an SST, or a green-top tube? Depends on what tests are ordered and what lab they go to. There is no easy answer to this question. Some labs use serum (SST tube), some use plasma (green top). Also depends on which anticoagulant is present in the green top (lithium or sodium heparin - latter is not used for electrolytes due to obvious false elevation of sodium). Best to check the specimen requirements in the catalog the lab provides. Judy Dilworth, M.T. (ASCP) Microbiology Btw, are chemistries supposed to use an SST, or a green-top tube? Douglas, You created quite a discussion on your low blood sugar. You should have gotten your repeat results back by now. Please tell us the results. We are all curious what is going on. Your silence is deafening.... Judy Dilworth, M.T. (ASCP) Microbiology On Oct 4, 10:31 am, "JEDilworth" <bactit...@nospamhortonsbay.com> wrote: > Douglas, > [quoted text clipped - 4 lines] > Judy Dilworth, M.T. (ASCP) > Microbiology 90 mg/dL...NORMAL! On Sep 25, 11:47 pm, "Manky Badger" <you.m...@be.joking> wrote: > As a matter of courtesy, it's probably best not to broadcast specific > individual's names over the Internet. There's around several million people w/ the name "Phan". ____________________________________________________ There's no helping you, is there? > > On Sep 22, 10:33 am, "JEDilworth" <bactit...@nospamhortonsbay.com> > > wrote: [quoted text clipped - 15 lines] > > Are you sure it isn't Dr Billass? Please don't insult my physicians. > > > On Sep 22, 10:33 am, "JEDilworth" <bactit...@nospamhortonsbay.com> > > > wrote: [quoted text clipped - 19 lines] > > - Show quoted text - I wasn't insulting your physicians as much as questioning your posting history motives as others here have noted. I think your doctors are saints in having to deal with difficult situations, hum patients. > If you had a glucose of 37 you'd probably be passed out. Then they would > take you to the ER and would perform glucose testing. They would [quoted text clipped - 47 lines] > > - Show quoted text - I will send you my lab results, then. The lab repeated it, twice. |
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