the_rck | (no subject)

Entry tags:

blood sugar,
health

(no subject)

I just got all of my test results back from Monday’s fasting blood draw. My doctor is concerned because my hemoglobin A1c is a little high. It’s 5.7%, and a normal range is 4.2-5.6%, so I’m not panicking or anything. It just means that getting more exercise is a more important goal. 5.7-6.4% is considered 'pre-diabetes.' The A1c is a measure of one’s average blood sugar over the course of the last three months, with the most recent month reflected most strongly. It has something to do with how much glucose is stuck to the outsides of hemoglobin cells. I’ve never had this test before, so I don’t have anything previous to compare it to.

I can’t tell, reading about the test, whether or not the fact that, for the preceding three and a half weeks, I’d mostly been eating simple carbohydrates— as opposed to my normal diet— would have had an effect. My normal diet has a lot less of those and good bit more protein, fat, and vegetables/fruits. It’s actually quite unusual for me to spend so long eating almost exclusively crackers, bread, pasta, white rice, and potatoes.

My fasting blood glucose was 93 mg/dL with 73-100 mg/dL being normal range. My fasting blood glucose last year, in May, was just barely this side of the line, 99 mg/dL. The year before that, in July, it was 100 mg/dL and, in January, it was 102 mg/dL. That last is high, and I was seeing the same doctor, but she didn’t flag it as important. Why do I suspect that me being 25-30 pounds heavier is a big factor in my doctor having a moderate freak out?

My doctor was planning to send me to a nutritionist anyway. I’m not convinced that’s likely to be useful because, in my experience, they can’t figure out how I can be eating so little and still be gaining weight, and they don’t believe me about what foods have which effect on me in terms of reflux, intestinal issues, and energy levels. They also don’t like it when I say that food preparation has to take less than fifteen minutes (and preferably less than ten minutes) or I just don’t eat.

I suspect that what I really need is some sort of personal trainer/exercise coach who could come to my house 2-4 times a week and help me get moving. Leaving the house, even just to bring in the trash cans, is pretty horrifically hard, and walking is likely to be my best bet for exercise just now. Getting myself into the basement to the treadmill is hard, too, and having someone to urge me on would help immensely. Walking— any form of exercise really— is so thoroughly unpleasant that it’s hard to do it.

My doctor recommended an exercise bike in preference to walking, but those hurt my knees if I go more than about three minutes, and the one we have has a terrible, terrible seat that really hurts. There’s a reason none of the three of us will use the dratted thing. Oh, and it’s kind of scary climbing onto the bike. The seat is high enough up when adjusted for me that I need to climb on something to reach it and then have to find a way to get whatever I used out of the way of the pedals.

Sadly, health insurance will pay for a nutritionist but not anybody to help me exercise.

Apart from the TSH, everything else we checked, including the pap smear, was fine.

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"they can’t figure out how I can be eating so little and still be gaining weight"

I had this problem for years. It turns out the problem was "despite regular thyroid panels looking fine, a complete lets-check-literally-everything blood draw determined that my thyroid is, in fact, Fucked."

I bet there are other things it could be, too, but you know. Ladies. Especially chubby ladies. Who believes them? Not that I'm bitter.

Yeah. Nobody much wants to listen to women, let alone fat women. I think I'm going to try to get a referral to an endocrinologist.

I ended up going to a doc who is, uh, a touch to the quacky side. I really don't care as long as he keeps giving me good care, which he is. I turn out to have a genetic variant which makes it hard for me to properly convert T4 to T3, so the usual treatment of Synthroid would not help. I'm on compounded T3 instead. Bodies! Who needs them! I need to be a brain in the jar!

I'm kind of confused-- My doctor asked if I wanted to see an endocrinologist. When I said I thought it might be a good idea, she told me she'd referred me to a nutritionist and ordered some further blood tests (though not the T3 I specifically asked for).

I may try to do the T3 without her if I can figure out how to make it work. There are companies that will do it, but I'd need to get the blood drawn, and I'd need to figure out which (if any) of the companies are even vaguely reliable. It looks like the price ranges from $25-$35, and I can swing that.

sadly, my response to this story is "oh yeah, that one". i ended up finding lists of good thyroid docs online and self-referring, because my GP was like "whatever, just take vitamin D, you don't need a referral to an endocrinologist".

honestly, the more I learn, the more I think that fatigue + inability to control weight gain + low vit D should be diagnostic of hypothyroid. in my case, i had low vit D despite it being early September, and me being outside 4+ hours a day all summer, with no sunscreen on my arms and legs (I am pale-skinned as hell and should have been manufacturing more than enough D under those conditions). I should NOT have had low-D at that point in the year, and that should have screamed that something was wrong.

I hope that the nutritionist can actually help, if only by perhaps recognizing that s/he is not the right person for this issue.

Is the TSH high? Did they check your T3 levels as well as T4?

The TSH is something like 7.32, so yes, it's high.

They did not check T3 to my knowledge. This was just my annual let's check to make sure nothing has changed blood test. We don't tend to dig too deeply unless we have a reason to think that something weird is going on. My TSH levels had been stable for two or three years before that, so my doctor didn't expect to see a change.

I had a high TSH for ages, and my doc. didn't do anything, even though my throat was sore all the time. It transpired that this was because my body was having to generate lots and lots of thyroid stimulating hormone to flog my thyroid into producing enough thyroxine. I was put on Levothyroxine, my sore throat went away, and my TSH went down. Later, when I was still slowly gaining weight despite eating a minimal amount of food, they tested my T3 levels, and found that they were low as well. Levothyroxine is T4. your body has to break it down into T3 for it to work in keeping your metabolism going at the right rate. Evidently, my body was not converting the T4 into T3 in sufficient amounts, so they put me on a combination of T4 and T3. I feel much better, am no longer constantly cold when others are fine, and can eat more - a reasonable amount - without putting on weight.

Interesting. That seems worth asking my doctor about. Thanks!

IME, "prediabetes" is a BS term that a certain class of medicos likes to throw around because they know the thought of diabetes scares most people. I have also *never* seen it given to a patient who did not also have "overweight" or "obesity" listed in their diagnoses, no matter their blood sugar/A1c numbers.

It's also not supposed to be given until one has two high fasting blood sugars *plus* a high A1c, and they are supposed to be in reasonable proximity to each other, not years apart.

One of the NPs tried to slap me with it because of two high blood sugars (one more than five years ago!), despite a lifetime of perfectly normal A1cs, and despite the fact that the "high" sugars (one was 106) were nonfasting. It had nothing to do with health and everything to do with her being very desperate to diagnose me with Something Terrible Due To Fat. When I brought it up to the doc, he removed it.

Eating little/gaining weight may mean you've tripped starvation mode (and eating *more* may help), but trust me, if you're the least little bit overweight, all you're going to be told by most professionals is to restrict restrict restrict. (I've actually started losing a bit since I started forcing myself to eat more than once a day.)

And I hear you on the difficulty of getting out of the house/exercising. I have neighbors from hell, plus a wacky little mental block that won't let me do "purposeless" activity. (I could walk to the mailboxes if they were closer, but walking just to walk around? Not happening.)

Also, seeing the TSH in the other comment--that definitely needs to be addressed. What trepkos said, pretty much.

I don't know if it would work where you live or if you have a smartphone, but I've found a game called Ingress somewhat helpful in terms of giving me a goal if I can get myself out of the house. The idea of it is to walk around with the program tracking you in order to get in range of 'portals,' game defined gps locations, to 'hack' them. You get points and game stuff for hacking, and there are two teams competing to capture and hold portals.

Someone on DW suggested that I might have issues with chronic high levels of epinephrine messing with my blood sugar.

I think your take on more exercise is very sensible. My HgA1c is also 5.7%, which prompted me to research the test. It seems that theoretically hemoglobin lives 3months, but if the actual lifetime differs, then the accuracy of this test is thrown off. There were some studies that suggested that hemoglobin in healthy people may live a little longer than 3 months, so their HgA1c may be higher than their blood glucose avg is; conversely hemoglobin in diabetic patients may live less than 3 months, driving down their HgA1c % even if their blood glucose avg is high. I couldn't find anything conclusive though, so I think fasting glucose, the glucose stress test
and regular glucose monitoring are good sanity checks for the HgA1c. Your fasting glucose numbers sound excellent, so I think you're right that your added weight is causing your doctor to freak out. Following up on T3 and TSH sounds like a good plan.

Too bad the nutritionist is unlikely to help. I guess you already did PT for post chemo :/. I looked into home helpers for my MIL to try to help with her health issues. Some of those were in-network for certain insurance companies like Blue Cross Blue Shield, and because of her chronic obesity and diabetes, insurance was willing to cover a certain number of visits/year. I wish insurance were more forward thinking about the value of exercise.

I know there are some diabetes prevention programs like omada health that increasingly are covered by insurance, but they seem to rely on remote monitoring and contact rather than having someone visit you and get you to exercise. I need a personal trainer too!

Edited 2016-05-26 00:19 (UTC)

Someone on DW said something that led to more research. I have huge issues with chronic anxiety, and apparently epinephrine suppresses insulin and can mess up blood sugar in ways that lead to simultaneous diabetes symptoms and hypoglycemia issues. I would be extremely surprised if I didn't have pretty constantly high levels of epinephrine.

More reason to want to see an endocrinologist I think.

Wow, fascinating! That would totally fit with your symptoms. Yeah, hope you can find a good endocrinologist to help you figure it out.

Bummer.

Hopefully a visit with the nutritionist will prove fruitful. In terms of motivation, are there DVDs or videos on YouTube that could help? Maybe something with personal trainers doing their motivational spiel if that works for you?

(I did the best on an at-home workout routine when I watched bicyclists tackle steep hills on narrow roads for the Tour de France on TV. Those hills were brutal, and the bystanders not always nice, and it totally made me feel ashamed to even think about stepping off the exercise machine in my comfortable, climate-controlled, leveled living room, with ice water and a fluffy towel within easy reach. I should've recorded it...)

*hugs*

My ability to deal with motivational stuff varies a lot. If it's not just right I get irritated with it. Almost every exercise DVD I've tried was too difficult. Even Yoga for All of Us asked for things I can't do. The best program I've found is Sit and Be Fit, and that's kind of saccharine. I used to be able to do half to two thirds of Body Electric, but no longer.

I really need to start out with something like two ten minute walks a day. I just tend to put things off. Even setting a time doesn't help because I know it's not a hard time point. Nothing will happen if I wait ten minutes until the song ends or empty the dishwasher instead.

I don't like youtube videos because I can't easily see my laptop screen at a safe exercise distance. I didn't find Sit and Be Fit there last time I looked, and the Body Electric episodes all appeared to be at least twenty years old, judging by the clothes, the hair, and the apparent age of Margaret Richards.

You know yourself best. Fingers crossed for you!

If your pancreas and insulin production is normal ie not diabetes then what you're eating will have no impact on what your hba1c is. Your body just releases more insulin to soak up the carbs.

That sort of result strongly implies diabetes but the health service hates type 2s and wants to protect statistics and so doesn't intervene with a full diagnosis until your health starts to get majorly impacted. It is completely wrong and unfair but it is being reported worldwide.

I know you aren't anywhere near me, but I do have a friend who has a personal training business where he comes to you, so it might be possible to find someone. That said, I'm not sure you want to use your energy on that right now.

I knew that such people likely existed. The real problem is money. Unless such a thing is covered by insurance, there's no way on earth to pay for it.

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