Dr. not listening

[Kosmo29]

Pre-diabetic here. So I went to my Dr. with my concerns. Hungry all the time, thirsty and urinating alot. Sweating alot and constpation. I am tired alot of the time and have done some self testing. Fasting over 100 and about 155-160 one hour post meal and around 150 2 hour post on a meter. So what's he decide to do .................................Wants to check my thyroid! No glucose test ordered. What do I do?

[princesslinda]

You could go and see an endocrinologist, though thyroid could be causing some of the symptoms you are describing.

[foxl]

If your blood sugars are THAT high, ask for an A1c, first ... they are inexpensive!

[Kosmo29]

Is that high, I thought you had to be 200 before you are diabetic?

[foxl]

Look up AACE's guidelines -- they are a little stricter than ADA's. American Academy of Clinical Endocrinology has a GREAT website!

[sorka]

I thought ADA was:

Diabetic if two fastings over 126

or

Two any time over 180 including post meal.

[plattb1]

Regardless ... if your doctor doesn't listen to you & respond appropriately ... you need another doctor.

[jps]

What do you do? Find a new doctor in my opinion.

Your concerns are certainly founded and it sounds like you want answers so you can do something about that. It really irks me physicians won't work with their patients. What you are asking for should be granted without his batting of an eye (based on the info you've given us).

As for diagnosis, by ADA standards (which are way too liberal IMO):


A random plasma glucose value of 200 mg/dl or more
A fasting plasma glucose value of 126 mg/dl or more
An oral glucose plasma glucose value of 200 mg/dl or higher at 2 hours post-glucose load

Keep in mind that most of the time, the FASTING glucose is the LAST place it will show.

IMO, you should get an A1c and an OGTT. I do understand his ordering of thyroid tests because that can be an underlying issue. But with the symptoms you are naming, it really does point strongly towards pre-D.

[MCS]

I am thinking the other way, maybe your Doc is just not talking with you. He wants to rule out a Thyroid problem before he starts you down the road of a D. But do not let him keep you waiting to long. You need answers.

[Abra]

That's funny, because my doctor told me two FBGs over 100 = diabetes.

[Kosmo29]

wow if that was true everyone would be diabetic!

[sarahspins]

I am thinking the other way, maybe your Doc is just not talking with you. He wants to rule out a Thyroid problem before he starts you down the road of a D. But do not let him keep you waiting to long. You need answers.

I agree.. your #'s are abnormal for sure, but not in the diabetic range exactly. If your doctor is running more tests, I wouldn't immediately assume they are dismissing your concerns - it sounds like they may be trying to rule some other concerns of their own out first. Thyroid problems can sometimes mess with glucose levels... especially combined with your symptoms, which with the glucose levels you supplied, can't really be blamed on those alone.

It takes a fasting # over 126 or a random or post-meal level over 200 to diagnose diabetes. Where you are falls in the "impaired glucose tolerance" range, what a lot of people like to call prediabetic. Whether you need meds or just diet/excercise adjustments is something that is up to you and your doc though... and it sounds like they're ruling some other things out first.

[butterflykisses]

After watching a report on diabetes and some of the less common symptoms I was sure I was diabetic. When I went in my doctor was convinced that I was NOT, told me that all my symptoms could be attributed to a thyroid condition. I didn't fit the "profiles"...too old for Type 1 (32), too young and thin for Type 2. I think his pride was hurt that he was wrong. ;) Just be persistent, especially if the thyroid panel comes back normal.

[jps]

I understand where the doc is coming from and he should rule out thyroid issues, but he should start with ruling out T2. Differential diagnosis is cheaper for diabetes and let's face it, the frequency of T2 diabetes is about 10,000x higher than those with thyroid issues. I think I'd start with the obvious (and cheaper) then move down the line.

[Kosmo29]

After watching a report on diabetes and some of the less common symptoms I was sure I was diabetic. When I went in my doctor was convinced that I was NOT, told me that all my symptoms could be attributed to a thyroid condition. I didn't fit the "profiles"...too old for Type 1 (32), too young and thin for Type 2. I think his pride was hurt that he was wrong. ;) Just be persistent, especially if the thyroid panel comes back normal.

What are some of the less common symptoms??

[foxl]

Emotional lability (overreaction/mood swings), sometimes even frank psychosis; muscle pain; mild -- MILD weight gain ...

These were ones I had, I also had hypo episodes at the same time and no one measured my blood glucose!

[butterflykisses]

What are some of the less common symptoms??

Well keep in mind that it has been like 13 years ago...but one that I remember that was driving me crazy was my legs itching. I was also nauseated, had headaches on an almost daily basis, and dizzy and I couldn't concentrate to save my life! I also had some of the classic symptoms like weight loss. They gave a link to an online "test", I think the ADA website, and after taking the test and reading more about diabetes I was convinced I had it. Wish I had insisted on more testing at the time because, although he did the glucose tests (random then fasting and an A1C), he just assumed I was a Type 2 I'm assuming based solely on my age. It could have saved me a lot of frustration!!!

[foxl]

Emotional lability (overreaction/mood swings), sometimes even frank psychosis; muscle pain; mild -- MILD weight gain ...

These were ones I had, I also had hypo episodes at the same time and no one measured my blood glucose!

These were hypothyroid symptoms, BTW ... not D!

[rimssathome]

Hello JPS,

Could you please let me know your c- peptide and HBA1C number the very first time you were diagonsed with diabetes.

Thanks

[jps]

Everything is in my signature below. I haven't had a C-peptide done yet, will have it done in the next couple of weeks.

[Kimbber]

You could go and see an endocrinologist, though thyroid could be causing some of the symptoms you are describing.

I second the endocrinologist. I saw four doctor over the past five years about weight gain, tired, lightheaded, mood swings, etc... I been told over and over it a women getting old thing. I final found an endocrinologist which this doctor's help I have lost 15 pounds in two months. I still have a long way to go and scared this is just another run around but at least I am loosing weight.

Kimberly

[UpNorth]

My friend is going through the exact same thing... Her fasting levels are good. But even as little as 30g of carbs will raise her to 10mmol/l or 180 in american numbers. And she's been having 2h readings of over 160 more than once.

If your doctor doesn't listen to you, change doctor! I keep telling my friend to change doctor, find someone who takes her levels seriously. She's frequented by headaches, dizzyness, nausea, difficulties to focus, tiredness and when she's thirsty she says it's difficult to feel satisfied when drinking water. She also has some rash on her leg. And still, all her doctor has done is taking a fasting level and A1c.

So find yourself a doctor who listen to you!

[LannyO]

You might Google Dr. M. Ali (NYC and NJ). You
should find some answers there. He's an alternative MD.
If you are pre-diabetic then a very low-carb diet might
be helpful. LannyO

[Lorac]

What is a C-Peptide? Some type of blood test? What does it tell you?

Also what type of test is done to tell whether you are resistant or not making insulin?

[jps]

C-Peptide tells you how much insulin you are actually making.

My understanding is this: Insulin has a short half life, C-peptide's is much longer.

The molecule proinsulin is released by the beta cells. It's inactive. When acted upon by enzymes, it's cleaved into two portions, insulin and C-peptide on a 1:1 ratio. So measuring C-Peptide is an indirect way to get a better picture of how much insulin you are producing.

Early stage T2's may have a high c-peptide because they are pumping out a ton of insulin to combat the high glucoses (or to try and maintain relatively normal blood glucose). But over time, beta cell burn out occurs and the c-peptide will drop. When it drops very significantly after long term uncontrolled diabetes, the T2 will certainly become insulin dependent because they aren't producing nearly enough insulin. They'll more closely resemble a T1 diabetic than an early stage or controlled T2 diabetic.

[Lorac]

I have my lab results. Is that something that something that is always done with bloodwork and what would it be called/named for me to be able to find it on my lab results. Does it have a more scientific name or abbreviation or something that I need to look for to see if I've had it done and what my #'s are?

[jps]

No, it won't be part of a routine workup. It'll have to be special ordered by the doctor.

If you need any help with what anything on the lab report means, feel free to ask...

[Lorac]

Thank you! Will do.