Just had my endo appt

EsMom · #1 (**permalink**) 11-06-2008, 11:12 AM

I just had my endo appt and I came out feeling like she didn't say much of anything. Basically, she told me that I'm insulin resistant and to just have an A1c checked 2 times a year (if I want), no need to check my blood sugars anymore unless I want to. She ordered the GAD antibody test but said no matter what it said she wouldn't change her treatment for me (just keep my weight in check - I weigh 117, 5'6", and eat healthy). I asked about the c-peptide and she said it wouldn't tell her anything about me. That it would only be helpful if we knew my glucose at that same moment. So she reluctantly ordered it but told me it wouldn't mean anything to her (she's basically doing it for me). I also asked if it was supposed to be done fasting and she said it doesn't matter since the only reason we're doing it is because we're just "fishing" right now. So basically, she ordered the tests, said i was fine and sent me on my merry way. I asked her should I not be concerned about 2 hour pp's in the 180 - 200's and she said no as long as my A1c and fastings are normal.

Argh - I don't know what to do. Should I just be thankful and move on with my life?

lorilei · #2 (**permalink**) 11-06-2008, 01:30 PM

I'm thinking get a "second opinion" !!! She did go to school, correct? If your BG has highs above 140, seems to me that that in itself is problematic. Well, guess you'll have to gain 50 lbs so she'll pay some attention to you and give you some real advice beyond..let's let this thing fester! I would absolutely keep monitoring your BG and keep the carbs lower. Especially if you're feeling symptomatic, and even if you're not. "In my opinion," be thankfully proactive!

owlyn · #3 (**permalink**) 11-06-2008, 05:26 PM

You know what they call someone who graduates last in the class at medical school?

You need a new one. Like now.

EsMom · #4 (**permalink**) 11-06-2008, 06:42 PM

That's what I'm thinking too, Owlyn! I was shocked that she didn't think the c-peptide and GAD antibody tests would tell us anything! From what I've read those are supposedly some of the "gold standard" tests. At least I got her to order the tests! And I'm going with my gut and the advice of another friend on this forum (Lori) and continuing to check my sugars and eat low carb in the meantime.

gettingby · #5 (**permalink**) 11-06-2008, 06:53 PM

Sorry but IMHO, she's off her rocker !!!!!!!!!!!

If it's possible, get another opinion. This is your life and your health. You need an endo who is concerned about your health and willing to work to find the answers to your questions. Too bad you don't live in Hickory. My endo is wonderful.

So is their new CDE.
Piedmont Endocrinology

EeyoreButterfly · #6 (**permalink**) 11-06-2008, 07:02 PM

Hmmm, my response disappeared. Let me try that again.

You should absolutely be concerned about readings between 180 and 200. I would go ahead an do the tests. Call the lab beforehand to ask what kidn of preparation you need to take.

Then, take those results to a different endo.

aeromarv · #7 (**permalink**) 11-07-2008, 09:35 AM

Agreed. Time for a new doctor. Even my pediatric physician when I was first diagnosed knew more than she seems to.

Ronin · #8 (**permalink**) 11-07-2008, 01:35 PM

Hi EsMom!

Find another Endo. Your weight for your height isn't that far out of line it gives you a BMI of 18.9 which is considered to be "healthy." That says that you are not obese, which is the first indication of being Insulin Resistant (IR).

My guess is that this particular Endo is one of those who presumes that all adult onset diebetics are Type-2's.

lilituc · #9 (**permalink**) 11-09-2008, 04:47 PM

Quote:

Originally Posted by EsMom

I asked about the c-peptide and she said it wouldn't tell her anything about me. That it would only be helpful if we knew my glucose at that same moment.

I've seen this before in guidelines for Medicare coverage of insulin pumps - The C-peptide is valid only when concurrent fasting blood glucose level is <225 but I don't know where that idea comes from. It doesn't make physiological sense to me. Also, to cover pumps, Medicare requires a *low* c-peptide. With a higher bg, you'd expect the opposite (assuming you still make insulin at all). So it really doesn't make sense to me. Do you have Medicare? Maybe someone else can explain what the deal is. It should definitely be taken fasting, though.

I can tell you, though, that if the concurrent glucose was really her concern, why didn't she just order the glucose test? That's what REALLY doesn't make sense to me.

Quote:

Originally Posted by EsMom

I asked her should I not be concerned about 2 hour pp's in the 180 - 200's and she said no as long as my A1c and fastings are normal.

You know, except for the "she" part, she sounds a lot like my old endo. To talk to him, you'd think no research had been done in the past 20 years.

Definitely try a different doctor.

EsMom · #10 (**permalink**) 11-11-2008, 01:49 PM

Thanks to everyone for your responses! They did draw the c-peptide and GAD antibody tests so do you think the c-peptide results will be useless since they didn't do it fasting?

Lilituc - you make a good point about why she didn't order the glucose test at the same time! If I'd been in a better state of mind I probably would have thought to ask her.

EsMom · #11 (**permalink**) 11-22-2008, 11:53 AM

Well, i got my results - the doctor mailed them to me. They didn't do the c-peptide fasting so it came back 5 (reference range 0.81-3.85). I had a pretty high carb breakfast that morning and since she said it didn't matter if i was fasting I assumed it wouldn't be accurate. The GAD test I have no idea what the results are. The only thing I see on this page is below and I don't know what it means:

<1.0 Reference range: <=1.0 Unit: U/ml

Any suggestions or comments??

Thanks!

lorilei · #12 (**permalink**) 11-22-2008, 04:26 PM

ESMOM, how
very vague! that is all it said on the paper? was it a testing/lab summary from the dr (ie transposed results??) or was it from the original lab? if se, is there no pass/fail/ hi/low column on the right? 9assuming all lab reports look similar... there was no follow up summary on the bottom..ie schedule appt immediately/3 mos/6mos? Did the lab script request the c peptide?

Funnygrl · #13 (**permalink**) 11-22-2008, 04:47 PM

Your GAD is negative, meaning GAD antibodies are not actively acting your beta cells. Your c-peptide is high, even for a post meal, suggesting insulin resistance.

I actually tend to agree with your doctor (except I would have told you to fast for the c-peptide). If your fastings and a1c are good, you're pretty clearly not diabetic, and there's no reason for very aggressive monitoring. You definitely aren't actively approaching type 1.

With your normal weight, I would guess you have a strong family history of diabetes?

EsMom · #14 (**permalink**) 11-22-2008, 06:13 PM

Funnygrl -

Nope, no family history of diabetes. So you're saying I shouldn't be concerned about post prandials that can get up into the 200's (most commonly 150 - 250 range)?

Ronin · #15 (**permalink**) 11-22-2008, 07:10 PM

Hi EsMom!

I agree that your C-Peptide levels are high. Therefore, I would tend to agree that you are headed towards Type-2 if you don't get your BG's under control.

Next question: what do you do for exercise? Consistent aerobic exercise gets muscles to develop more insulin receptor sites and your body uses more glucose. Combine regular exercise with a low-carb diet and you can control your BG levels better.