Alan is not the most communicative patient from what I see in your posts.
You seem to be his advocate.

The whole glucose test looks weird. At his age there should be some
increase --even basically a little in the 1st hour.
His first hour after the challenge is lower than most people's fasting.

I would monitor him at home, still and keep a diary. I would check him after a workout, BEFORE he eats or drinks anything. Ask him if he gets shakey at the end of the workouts. He may attribute sweating then to the workout, and
not low blood sugar if it happens then.

The numbers are rather confusing...and meaningless when viewed out of context. One has to ask, where did all that sugar go? and why so fast? If you look at other graphs, you
can see there is wide variation.
http://hypoglykemie.nl/gtt.htm

If you plug the #s into the basic graph at that website, you can see Alan is
mostly like the purple (last ) line.

I guess if doctors do not get "complaints" from you...and your numbers are low, (not high indicating diabetes), they just ignore the rest?

Most symptoms of hypoglycemia occur with huge shifts in levels. Alan does
not present with this. HIs readings do not spike quickly with time. They are all blunted.
Here is another website:
http://www.digitalnaturopath.com/cond/C18537.html

One thing you can do is to measure his sugar when he "complains" that his PN is bothering him. This in fact may be the dip (and in males below 50 is significant) in blood sugar at home.

No matter what is going on...those reading are atypical. Whether to believe them or not? Well, I'd still get the fasting INSULIN done. It is easy, and you have had everything else..so why not follow thru with that?

Here is an interesting Wikipedia entry:
from http://en.wikipedia.org/wiki/Hypoglycemia

Good idea:

Today, as soon as he comes home I'll take his blood sugar.

I'll take it every morning also.

I'll keep a chart.

And you are right about Alan not being communicative. Where do you think our son got his Aspergers from? I think it's genetic.

After being married to Alan for 25 years, he's much much better. More outgoing, Took being married to me for him to grow and change and learn how to communicate more easily. He does get along famously with Dr. Fred. Perhaps because they meet up at the gym from time to time. Alan is not like me whatsoever. I could go into a room and know everybody in two minutes flat. He's a very quiet keep to himself kind of person. When I met him he was a private investigator. I thought I married Magnum PI. Isn't that hysterical.

But all that changed once our son left us and decided he didn't need family. Very hard on Alan, believe me. WE never saw it coming and we had never heard of Aspergers disorder.

He monitors these boards but he's not the type to post. He says he can't type as fast as me and he doesn't understand all the medical speak. He says that's why he has me. I laughed. Imagine if he had Mrs. Doubtfire.?

So I'll start writing down his numbers at different intervals.
Then we'll see where we shall go after that.

be well and thanks much.
Melody

I have heard people telling me that they have had the post spinal tap headache. My cousin Billy Boy once had a hernia operation. He had a spinal for that. They told him, don't pick up your head.

He stupidly did and he went crazy and they had to give him morphine.

So after the spinal tap, and he rests in recovery, and we get on the access-a-ride, it's about a 30 minute ride till we get home. What do I do?. Do I sit behind him and hold his head still. Honestly, we don't have anyone to pick us up. We have no family. So we are all we have. The doctor assured me that if he rests in recovery from the 10 a.m. procedure, he should be good to go home at 2 p.m. and once he gets home, all he has to do is lie down for the rest of the day. Is that good enough?.

Also, (and I just called the neuro-radiology dept because Alan had a very good question. He has trouble lying still because of his PN. I told him "but you had an angioplasty and a stenting, and you were fine" and he told me "they gave me morphine, don't you remember?? I said "oh, yeah"!!

So what does a person with PN do when they have to lie still and they can't lie still for 2 hours. Can he move his legs a bit after the spinal tap?

I thought it was just the head you couldn't pick up.

Any thoughts? Thanks,
Melody

P,.S.

He just came home from the gym at 4 p.m. . I immediately took his blood sugar as soon as he came in the door. It was 103. He had eaten a muffin 40 minutes before coming home and he had been exercising for 3 hours and then had the muffin. So he got to the gym at 11:30 a.m. began exercising, did it for 3 hours, had a muffin, came home 40 minutes later and his sugar was 103. Mean anything????

The muffin is all carbs, and it skews the results.

You need to test him with no food/or drink (except water).
Ask him if he can do this...if not...it is revealing that he feels pretty terrible.

One can move around, roll over etc after a spinal. Just not lift the head.
The stent went in the groin and moving the leg could cause bleeding.
You don't have that restriction with the spinal.

--that the pattern is not suggestive of an insulinoma.

An insulinoma would be more likely if Alan had a low fasting blood sugar that continued to drop with continued fasting; the standard test in bygone years was a fast of up to 72 hours. If insulin secretion is not suppresed in the presence of falling blood sugar--they have to be measuring both insulin and glucose during the fast--the likelihood of insulinoma rises.

Since the insulin/glucose balance is a mutual feedback mechanism, in normal people, the body tries to maintain a baseline blood sugar level. If no additional food is being ingested, there is no need for insulin to be produced in appreciable quantities, as there is no need to push excess glucose into the cells (there is no excess glucose) and the insulin level drops. Normal people on fasts often have fairly in-range glucose levels (unless the fast is very long, or they have no fat stores) but low insulin levels until they start consuming food again. But in people with insulinoma, insulin levels stay high, as the tumor is producing excess insulin.

Moreover, insulinomas tend to produce high levels of "proinsulin", a slight chemical variant--generally, "normals" do not have more than about 20% of their serum insulin identifiable as proinsulin, whereas with insulinomas, generally there are percentages of 24 or higher. High c-peptide levels can also be indicative. (These can all be measured.)

While I agree that Alan's insulin levels should be measured (and I wish they did it during the 3-hour test), they should also measure his proinsulin and c-peptide levels. But, while I'm not a physician, I do not suspect insulinoma in him, primarily because he does not seem to exhibit the fasting hypoglycemia or the disorientation, palpitations, weakness, and weight gain associated with it.

Now, there are many other reasons his blood sugar may have gone that low in the third hour, and that should be investigated--these could range from other endocrine disorders to pre-diabetic insulin resistance. (I so wish they had taken samples every half-hour along with insulin levels during the three-hour test--would have been interesting, and likely instructive, to see the patterns in the rise and fall of both. If they do a multi-hour test again, insist they do it with half-hour measurements and insulin levels.)

More places to learn about this:

www.emedicine.com/med/topic2677.htm

http://www.indegene.com/JIACM/indJIA...glycaemia.html

WEll, when I wake up tomorrow morning and I take my sugar, I'm also going to take his. So that will be after not eating anything all night.

So that might tell something??? right???

jeez. all this peptides, and whatever, I might just go to nursing school like my mother did at the age of 50.

mel

Melody,

I've talked to people who have had spinals, and absolutely no headaches at all.... my doc had me lay in her office for about two hours - then sent me home where I had to sit in a car for about an hour and a half (I had the seat reclined) - when I got out of the car the back of my sholders, head, and neck were really hurting - and the pain was severe for about 5 days (had to lilterally lay flat in bed the whole time) .... I think if the doc had let me stay longer then two hours I might have been in better shape...... (by the way, the actual spinal itself didnt hurt at all)

Sometimes if you do get a spinal headache they do a "blood patch" - inject some of your own blood into your spine to replace the missing fluid and it can be effective... for some reason because I also had sholder and neck pain my doc said it wouldnt work so just had to lay there....

So, I'd just try to get as much laying down time before you leave as you can - just in case (I believe they used to tell people six hours)

Hi kmeb:

Well, his procedure is scheduled for 10a.m. and the doc is giving him an extra hour in recovery so he said a 2 p.m. pickup from the access-a-ride people should be fine. That makes it 4 hours from beginning of procedure till the time we are picked up. They may make it 2:30, it all depends on what time the access-a-ride gives us.

Do you think the hospital will let him lie down as long as he needs to until the access-a-ride arrives to pick us up?

This is his first spinal tap. He'll be on cymbalta (I think he goes to 60 on Sunday) so that should do something for his pn discomfort if he has to lie down for 4 hours.

The doctor said "many people have no headaches at all, and some do. It's just a matter of following the rules the best you can.

I can't imagine what they might find in his spinal fluid. I mean, is there anything that relates to his neuropathy that might be found in his spinal fluid???

be well
melody

Hi again,

I think if you ask at the hospital - they will let Alan stay in recovery (if he has too - just tell them he's NOT feeling well and needs more time)...... I was very skeptical of only having two hours from start of procedure to going home and I should have listened to my gut (the doctor just did it in her office).... 'cause man those next five days it hurt (although I have to admit I've never felt so rested)!

As far as exacty what they might find - I'm not the expert on that - but - (Glenn???) I had it early on when I got PN - I believe they were looking for auto-immune markers when they did it.......

I dont think you need to lay perfectly still - just not get up and down is the goal - keeping your head flat so the fluid can sneak back where it belongs!

(also, while riding in access - maybe he can lay flat across a seat just for extra caution!)

Well, when the access-a-ride shows up, if there are no other passengers, I can ask the driver if he'll let Alan lay down with his legs over my lap.

On the left of the acess-a-ride is a two seat thing and on the right a one seat thing. So if no one is sitting in the two seat thing, Alan can lay down and put his legs on my lap. That would work fine. That is if the Acess-a-ride driver will bend the rules. If he speaks French (and most of them do) maybe I can impress them by conversing in French. I always do that and you should see the look on the those guys' faces when I start saying Bon Jour, Monsieur, comment t'allez vous, aujourd-hui. Good morning, how are you today?

They look at me and sometimes (like when I go to Cornell and it's an hour ride), we jabber away in French and the other people on the bus get hysterical, especially if some are italian, then I get to speak italian and french. One day, Alan said "i've got a headache from all these languages"

WE laugh on those rides. I do hope I get a nice driver that day. I'm also going to price a private taxi and if it's not too much, maybe we'll go that route.,

I phoned up Empire Blue Cross and asked them if they would cover an ambulette for the ride home but they said "sorry, we don't do that".
Oh well, it's one trip. Won't kill him.

mel
P.S. I just took his sugar, at 10 p.m. he ate dinner (turkeyburger, veggies, baked potato and salad at almost 7 pm. His sugar reading at 10 p.m. was 95.

Tomorrow morning, we'll do it again. before breakfast.


over and out.
melody