questions re: tests/diagnosis

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questions re: tests/diagnosis

Postby kiley » Thu Nov 08, 2012 9:08 am

hi-
so glad to find this site as i am getting the runaround by medical establishment.
will try to cut this short but here's the gist:
have been diagnosed with 'pre-diabetes'. actually she said 'mild glucose intolerance problem'.
have had several high fasting bg tests (100-120) and had 2, 2 hour OGTT tests. the first one said after 2 hr.s i was at 216. second tests had me at 207 after 1 hour and normal at 2 hrs.
i went into hyploglycemia event at one tests, 2 1/2 hr.s after drinking the glucose--almost passed out.
some of my sporadically taken fasting bg tests were within normal range.
questions:
---isn't it common for a diabetes patients to have SOME normal fasting bg?
----why would glucose be high at 1 hr and then normal at 2nd hour?
------what does it mean that i went into hypoglycemia?
endocrinologist did not care that i went into hypoglycemia and only the nurse went over the results with me. dr.'s only suggestion was that i see a nutrionist. i am thin and, as i explained to the dr, and eat very 'clean'. i was the one to suggest metformin so that this does not progress.
there is no diabetes in my family and i tested neg. for antibody so this would likely be type 2.

the rest of my questions have to do with addison's testing.
the endocrinologist tested my a.m. blood coritsol and acth. NOT stimulation, not saliva, not throughout the day. both were normal so dr. does not want to do further tests.
reason this came up was that i was having several sx.s indicative of addison's and recently had 1 major eye surgery and 3 other, less invasive, eye surgeries. unrelated, btw, (SUPPOSEDLY) to my blood glucose problems.
question:
do these tests prove that I do not have addison's for sure?
hospital also discovered i have 'pots' (orthostatic hypotension).
i feel as if i am getting dropped thru the cracks with help and proper testing.

i know you are not dr.s and do not know me, but any suggestions or related experiences would would be greatly appreciated! i really need the advice!
MANY THANKS, kiley
kiley
 
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Re: questions re: tests/diagnosis

Postby kiley » Fri Nov 09, 2012 9:37 am

sorry to be so long-winded!
and here i was trying to cut to the chase. : )
thank you!
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Re: questions re: tests/diagnosis

Postby gkardel » Sun Nov 11, 2012 10:35 pm

Kiley,

---isn't it common for a diabetes patients to have SOME normal fasting bg?
depends what state of the condition you're in: early......advanced.

----why would glucose be high at 1 hr and then normal at 2nd hour?
insulin hit your system too late

------what does it mean that i went into hypoglycemia?
insulin hit you're system too late and perhaps too much.

OGTT is outdated. Better tests are insulin level and c-peptide.

Why do you think you have Addisons?


-Glenn
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Re: questions re: tests/diagnosis

Postby kiley » Mon Nov 12, 2012 7:22 am

hi-
thanks so much for checking in with me!
it's not that i think i have addison's. am just hoping to rule it out entirely and make sure dr. did proper testing. have had a few dr.s seriously screw up with me and now i am very careful that i don't keep slipping thru the cracks.
i have many symptoms that COULD fall into low cortisol as an explanation but of course, that is not the only possible cause and i do know that addison's is rare.
i had 4 eye surgeries and have been pretty ill for the past 3 months after last one. kidney problems (spilling albumin), profound fatigue, no appetite/weight loss, salt craving, etc.
everything i've read says that an acth stimulation test is the way to diagnose or rule out.
i have been on prednisone sporadially in the past for lupus. maybe that caused secondary adrenal problems?
----again, is that the proper, complete testing for ruling out adrenal insufficiency?
only cortisol test i had was in the a.m. and was normal so perhaps the dr. thought that was enough. just wondering if she was correct.
am still wondering how to monitor the pre-diabetes too. she pretty much blew me off about that.
---- i'd like to prevent full-blown but cannot lose weight or change diet.
------any suggestions?
----what does it mean that insulin 'hits my system too late'?
---if you are pre-diabetes, shouldn't you check your bg periocially at home?
thanks again, kiley
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Re: questions re: tests/diagnosis

Postby captex » Mon Nov 12, 2012 7:43 am

Kiley,

You need to ACTH Stim Test to determine if you have a Pituitary issue or Adrenal Failure. If the baseline is low, that would answer most of your questions. Personally, I have no confidence in the Saliva test. But some seem to give it credit.

I would not give up your effort to get to the bottom of this. My BP dropped to 50/30 when I went into Crisis and they still didn't figure it out. Low Cortisol, Low Sodium are common for persons with Secondary Adrenal Insufficiency. Most will say that Low Sodium is not usually a concern, but it was and still is for me.

captex
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Re: questions re: tests/diagnosis

Postby gkardel » Mon Nov 12, 2012 9:28 pm

Prednisone can cause secondary adrenal insufficiency. It can also bring on type 2 diabetes. The higher the dose, the higher the risk of side effects. If you aren't tapered off the steroids appropriately can also cause problems.

Big part of blood sugar control is about matching the glucose in your system with the correct amount and timing of insulin. Both glucose and insulin have a period of action in your system. After you eat, food is digested and broken down into sugars that your body can can utilize for fuel with the help of insulin. If the production of insulin is delayed relative to the timing of glucose, then your sugar will first go high and then be followed by low blood sugar. The normal functioning body really performs an amazing balancing act to maintain normal blood sugars.

-Glenn
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Re: questions re: tests/diagnosis

Postby kiley » Wed Nov 21, 2012 3:07 pm

thanks guys!
i never got an email notification about the replies so am glad i caught this.

glenn, yes, understand the tie to prednisone. thank you, good thought.
has been about 6 months since last on very low dose of pred. and i always wean off but perhaps the use was enough thru the years to have caused problems, i know.

captex- may talk to my g.p and see what she thinks about pursuing acth stim. and sodium tests. do not want to call the endo. she wasn't welcoming of questions.
wow, that was a scary b.p. you had!
i was 90/45 last week and no one was concerned, so that's good i guess. but i am sick of hearing from dr.s how wonderful it is that i have such a low b.p.--it's not always healthy, as we know.
------since my a.m. cortisol was normal, do you think i should bother to pursue the acth stim?
--------does often having low serum co./oxygen mean anything to adrenals? i am not at all nervous at dr.s, but they always say' oh, everyone has stress at the dr. and that causes a high reading so don't pay attention to that"

hope y'all are feeling great and thank you for the help with this!
kiley
 
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Re: questions re: tests/diagnosis

Postby kiley » Wed Nov 21, 2012 3:14 pm

oops, forgot glenn....
THANK YOU for suggestion of newer, different b.g./diabetes testing! am saddened that my endo. wouldn't know that but, oh well.
may pursue that with my g.p. at a later date.
happy thanksgiving!
kiley
 
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Re: questions re: tests/diagnosis

Postby captex » Fri Nov 23, 2012 4:43 pm

kiley,

My "normal" bp ranges from a high of 120/80 or so when I very Stressed to 75/45 on many evenings. I've learned to accept the lows. I am a Secondary Adrenal Insufficient individual. My BG never dropped, in fact, it went up. I've had several AI Crisis' and they are not pleasant experiences to say the least. If you have quite a few of the symptoms, I would get the ACTH done. You could be at the early phase of the disease. You have to lose 90% of the functionality before it becomes critical.

captex
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Re: questions re: tests/diagnosis

Postby captex » Sat Nov 24, 2012 12:53 pm

Sorry for the bad grammer.... I didn't edit my errors

it should have read...

My "normal" bp ranges from a high of 120/80 or so when I'm very Stressed, a normal of 75/45 on many evenings. I've learned to accept the lows.

I am a Secondary Adrenal Insufficient individual. My BG never dropped, in fact, it went up. I'm a Type II Diabetic. I've had to add both Levemir and Novalog to my meds. I did get to drop Glipizide.

I've had several AI Crisis' and they are not pleasant experiences to say the least. If you have quite a few of the symptoms, I would get the ACTH done. You could be at the early phase of the disease. You have to lose 90% of the functionality before it becomes critical.

EDITED FOR CLARITY:
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Re: questions re: tests/diagnosis

Postby kiley » Thu Nov 29, 2012 4:17 pm

no apology or editing necessary.
you did a beautiful job of sharing information and i appreciate your replies!
as you can see, due to my fatigue i do not bother with using upper case letters in my writing now; too much work. : )
thanks again, kiley
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